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date: 21 July 2018

Mixed Methods Research in Adult Development and Aging

Summary and Keywords

Mixed methods research consists of collecting and analyzing qualitative and quantitative data within a singular study. The “methods” of mixed methods research vary, but the ultimate goal is to provide greater understanding and explanation via the integration of qualitative and quantitative data. Mixed methods studies have the potential to advance our understanding of complex phenomena over time in adult development and aging (e.g., depression following the death of a spouse), but the utility of this approach depends on its application. The authors systematically searched the literature (CINHAL, Embase, Ovid/Medline, PubMed, PsychInfo, and ProQuest) to identify longitudinal mixed methods studies focused on aging. They identified 6,351 articles published between 1994 and 2017, of which 174 met the inclusion criteria. The majority of mixed methods studies reported on the evaluation of interventions or educational programs. Non-interventional studies tended to report on experiences related to the progression of various health conditions, the needs and experiences of caregivers, and the lived experiences of older adults. About half (n = 81) of the mixed methods studies followed a sequential explanatory design where a qualitative component followed quantitative evaluation, and most of these studies achieved “integration” by comparing qualitative and quantitative data in Results sections. There was considerable heterogeneity across studies in terms of overall design (randomized trials, program evaluations, cohort studies, and case studies). As a whole, the literature suffered from key limitations, including a lack of reporting on sample selection methodology and mixed methods design characteristics. To maximize the value of mixed methods in adult development in aging research, investigators should conform to recommended guidelines (e.g., depict participant study flow and use recommended notation) and consider more sophisticated mixed methods applications to advance the state of the art.

Keywords: gerontology, older adults, mixed methodology, longitudinal research

Introduction

Among the principal goals of science are to describe a certain phenomenon by its measurable characteristics, as well as to ascertain why such a phenomenon occurs. For this reason, scholars across disciplines often use various methodologies (ways of knowing/thinking about research) and methods (ways of doing research) to describe a phenomenon, to ascertain its relationship to other phenomena, and ultimately to understand how and why a phenomenon operates in a given context. In the larger philosophical sense, the decisions that underpin approaches to science are rooted in epistemological (how truth is discovered) and ontological (the nature of truth) concerns, although for many scholars the focus is often deploying those methodologies and methods that are most appropriate to answering questions of interest in as rigorous a fashion as possible.

The many complex, longitudinal processes of adult development and aging would seem to lend themselves well to the use of various methodologies and methods, and indeed, a brief survey of current peer-reviewed publications in gerontology suggests that robust lines of quantitative and qualitative inquiry exist. But how often do adult development and aging scholars integrate different sources of data or consider mixed methods when answering questions of interest? What do such efforts look like? Perhaps as important, do mixed methods research approaches have anything to contribute to the state of the science in adult development and aging? These are among the key questions this article seeks to address when considering the landscape of mixed methods in longitudinal aging research.

A Brief History of Mixed Methods

The “paradigm” wars of the 1970s and 1980s that roiled many social science disciplines led to a number of methodological initiatives to bridge the divide between qualitative and quantitative research camps (Creswell & Plano Clark, 2010; Morgan, 2007; Small, 2011). These efforts led to the emergence of “mixed methods,” often positioned as a third methodological framework to consider as a scope of inquiry in the behavioral and social sciences (Tashakkori & Teddlie, 2010). While a formal language and standardization of mixed methods could be considered a more recent development, the combination of qualitative and quantitative data has been used in the behavioral and social sciences since at least the early 20th century (Campbell & Fiske, 1959; LaPiere, 1934). Moreover, philosophical debates dating back to ancient times suggest the ongoing tension, and attempted integration, of “ways of knowing” (Johnson & Gray, 2010).

A fairly common definition of mixed methods research is that it “. . . is the type of research in which a researcher or team of researchers combines elements of qualitative and quantitative research approaches (e.g., use of qualitative and quantitative viewpoints, data collection, analysis, inference techniques) for the broad purposes of breadth and depth of understanding and corroboration” (Johnson, Onwuegbuzie, & Turner, 2007, p. 123). Though some scholars (e.g., Morse & Niehaus, 2009) consider studies that include two qualitative components or two quantitative components as “mixed methods” designs, mixed methods texts more commonly adhere to the definition of combined qualitative and quantitative components (Creswell & Plano Clark, 2010). Among the core components of mixed methods are the collection and analysis of both qualitative and quantitative data; integration of qualitative and quantitative data concurrently, sequentially, or by “embedding” the qualitative or quantitative study component (or “strand”) into the other; lending priority to one strand or both; and mixing study components in a singular or multiphase program of study (Creswell & Plano Clark, 2010). Mixed methods researchers are careful to distinguish from “multimethod studies,” in which two or more qualitative or quantitative research methods are conducted within the context of a given project (Creswell & Plano Clark, 2010). Multiple methods are often employed in studies where each method can answer different questions within a project, but where the results are not necessarily integrated or even compared. In a mixed methods design, researchers employ various qualitative and quantitative research methods with the goal of integrating these findings to provide more robust answers to research questions of interest within a single project. The approach is not limited to convergence or comparison of data. Rather, researchers further seek corroboration, elaboration through richness and detail, and inspiration through new interpretations and research questions to explore.

Mixed methods studies often aim to answer questions that require more complex, real-world contextual insight; this can occur via the rigorous conduct of identifying and describing constructs and their relationships quantitatively and then probing the meaning of such constructs and their relationships through in-depth qualitative inquiry. Mixed methods can operate on or influence three “planes” of science: (1) paradigm, or how we think about and study “truth” (some have positioned mixed methods as paradigmatic in scope, or have aligned this scientific approach with paradigms such as pragmatism and dialecticism; Glogowska, 2011; Greene & Hall, 2010; Morgan, 2007; Shaw, Connelly, & Zecevic, 2010; Yvonne Feilzer, 2010); (2) methodology (the study of scientific methods, or their rationale and assumptions—i.e., ways of thinking about methods); and (3) methods (procedures, data collection tools, analysis, etc.—i.e., ways of doing methods).

A number of reasons exist to consider a mixed methods approach (Creswell, Caroll Klassen, Plano Clark, & Clegg Smith, 2010). For example, one source or type of data may be insufficient to address the question or concept at hand. In addition, a need may exist to explain initial results originally collected within a single qualitative or quantitative study, generalize exploratory findings, or enhance a study within one or more additional follow-up study strands (Bryman, 2006; Creswell & Plano-Clark, 2010, pp. 8–11). While “mixing” often occurs at the methods level, mixing can also take place at the methodological and even paradigmatic levels (e.g., exploring the tensions between interpreting results within a post-positivist and constructivist paradigm; Betzner, Lawrenz, & Thao, 2016; Greene & Hall, 2010; Muncey, 2009). Mixed methods are often used when the research question dictates the use of this approach—for example, attempting to discern not only whether something occurs, but how and why. Triangulation of findings and understanding of process are other compelling reasons to adopt mixed methods.

There are several key considerations when conducting mixed methods (Creswell et al., 2010). Issues of resources are often pressing, as the analytic expertise and dissemination skills necessary to conduct mixed methods can often make the conduct of such studies challenging. Constructing aims that are aligned with mixed methods is also important, as in many instances the key questions/hypotheses posed are not amenable to mixed methods. The timing and sequencing of study components (i.e., the qualitative and quantitative strands) also require careful consideration when constructing aims and the given design of a mixed methods study. Perhaps most important is determining what the “point of interface,” or integration, is within a mixed methods study; simply conducting two rigorous qualitative and quantitative study strands is insufficient, since the benefit and rationale of mixed methods is to effectively integrate these two sources of data.

As Table 1 shows, a notation system has been developed to describe the numerous design possibilities in mixed methods, particularly when one takes into account the timing, sequence, “prioritization” (i.e., whether the quantitative or qualitative strand is “driving” the study purpose), and various approaches to integration (Creswell & Plano Clark, 2010; Morse, 1991; Morse & Niehaus, 2009). There are three design types specified by Creswell and colleagues. A convergent design merges qualitative and quantitative data simultaneously to address a question of interest. A sequential design is where one strand builds upon another (e.g., a quantitative strand followed by a qualitative strand or vice versa). An embedded design nests one strand into another to provide greater insight when addressing a particular study aim. Embedded designs are prominent in many randomized controlled evaluations, where qualitative elements are embedded prior to, during, and/or following the implementation of an intervention to offer insights into process of implementation, mechanisms of benefit, or other critical questions. Multiphase designs, which are often seen in large-scale, multiyear program evaluations, link multiple projects collecting qualitative and quantitative data over time.

Table 1. Summary of Notations Used to Describe Mixed Methods Designs

Notation

Example Application

What the Notation Indicates

Key Citations

Shorthand: Quan, Qual

Quan strand

Quantitative methods

Morse (1991, 2003)

Uppercase letters: QUAN, QUAL

QUAL priority

The qualitative methods are prioritized in the design.

Morse (1991, 2003)

Lowercase letters: quan, qual

qual supplement

The qualitative methods have a lesser priority in the design.

Morse (1991, 2003)

Plus sign: +

QUAN + QUAL

The QUAN and QUAL methods occur concurrently.

Morse (1991, 2003)

Arrow: →

QUAN → qual

The methods occur in a sequence of QUAN followed by qual.

Morse (1991, 2003)

Parentheses: ()

QUAN(qual)

A method is embedded within a larger design or procedure or mixed within a theoretical or program-objective framework.

Plano Clark (2005)

Double arrows: →←

QUAL →← QUAN

The methods are implemented in a recursive process (QUAL → QUAN → QUAL → QUAN → etc.).

Nastasi et al. (2007)

Brackets: []

QUAL → QUAN → [QUAN + qual]

Mixed methods [QUAN + qual] is used within a single study or project within a series of studies.

Morse & Niehaus (2009)

Equals sign: =

QUAN → qual = explain results

The purpose for mixing methods

Morse & Niehaus (2009)

Note: Adapted from Creswell & Plano Clark, 2010, p. 109

Mixed Methods in Adult Development and Aging: The State of the Science

There have been few if any efforts to date that systematically examine mixed methods in adult development and aging. In many ways, mixed methods could serve to advance our understanding of how phenomena change over time or how older persons develop in key contexts. Furthermore, the use of mixed methods could facilitate our understanding of the feasibility and acceptability of various interventions (e.g., cognitive training, caregiver interventions), and also help us understand the processes of implementation and benefit of these interventions. The objective of this article is to provide an initial overview of the state of mixed methods research in adult development and aging, and in synthesizing this research, to outline how mixed methods could be effectively conducted to further advance adult development and aging science.

Methods

The authors performed a systematic review to identify longitudinal studies focusing on aging using mixed methods. Using the mixed methods syntax provided by Morse and Niehaus (2009, pp. 167–180) as a foundation, databases searched were CINHAL, Embase, Ovid/Medline, PubMed, PsychInfo, and ProQuest (syntax was updated to meet current database search language criteria). Article selection criteria included (a) original research, (b) use of mixed methods, (c) longitudinal design, (d) focus on an aging sample or caring for an aging sample, and (e) written in English. Original research was defined as primary data collection (i.e., not a systematic review or protocol). To be considered mixed methods, manuscripts had to involve the collection and analysis of both quantitative and qualitative data components or “strands.” To be considered longitudinal, the same participants had to be followed over some length of time. Aging had to be the explicit focus of the article (e.g., nursing/medical students who worked with older adults, family caregivers of older persons) or the average age of study participants had to be 65 or older. The review was restricted to articles written in English given the language abilities of the authors. Exclusion criteria included protocols, measurement development studies, and other study characteristics that did not meet the inclusion criteria above (e.g., did not follow the same sample over time). Articles were also excluded if they presented only the quantitative or qualitative portion of a larger mixed methods study. Time/date of publication was not considered as an inclusion/exclusion criterion.

The initial database search retrieved 6,351 articles, which was reduced to 3,714 after duplicates were removed using EndNote8x tools. The second author (CMP) performed an initial, brief screening of titles and abstracts to identify potentially eligible research articles (reducing the selection to 412 articles). As a group, the authors reviewed these 412 articles’ abstracts in detail in two separate screening sessions. Two hundred and twenty-eight were identified for inclusion based on available detail in the abstract. The second author then randomly assigned the 228 articles to all authors to obtain and review each article (approximately 46 articles were assigned to each author) to (a) determine their final inclusion and (b) extract key data for the literature synthesis.

Mixed Methods Research in Adult Development and AgingClick to view larger

Figure 1. Modified PRISMA systematic review flow diagram (Moher, Liberati, Tetzlaff, & Altman, 2009).

The lead author (JEG) created a data table to extract key information from mixed methods studies included in the final review. The categories included were selected based on the aims of the present study, as well as prior reviews of mixed methods research (Curry et al., 2013). The following categories were coded and are included in Table 2: (a) basic article information, (b) content information (e.g., discipline, study purpose), (c) information about quantitative and qualitative strands (e.g., sampling, data collection, analysis techniques), (d) mixed methods features (e.g., reasons for mixing and timing), (e) longitudinal features (e.g., study duration, number of repeated measures), and (f) longitudinal mixed methods design (using the mixed methods notation specified in Table 1; Creswell & Plano Clark, 2010; Morse, 1991; Morse & Niehaus, 2009).

An additional 37 articles were excluded because they did not fit the inclusion criteria after review of the full text; 17 additional articles were not included because the full text could not be retrieved. The final sample for this review was 174 mixed methods longitudinal studies on aging articles published from 1994 to 2017 (see Figure 1).

Results

Study Methodology

Mixed methods studies were rarely “embedded experimental” evaluations where qualitative data were integrated into a larger randomized controlled trial (RCT) to fully evaluate the efficacy/effectiveness of a given intervention. Instead, mixed methods designs were more often used to develop and pilot interventions, implement given programs, or examine treatment fidelity or other process issues. Many existing studies in adult development and aging appeared to deploy mixed methods for program evaluation purposes in quasi-experimental designs. There were comparatively fewer studies that used mixed methods in longitudinal, descriptive analyses (for an exception, see Quine, Wells, de Vaus, & Kendig, 2007; data from a large prospective panel survey were combined with focus groups to explore the association between sense of choice in retirement decisions and well-being following retirement).

Specifically, intervention studies that adopted mixed methods tended to focus on the development, treatment fidelity, process evaluation, and acceptability of interventions for older adults (e.g., Auger, Miller, Jutai, & Tamblyn, 2015; Danilovich, Hughes, Corcos, Marquez, & Eisenstein, 2017; Gammonley, 1999; Kullgren et al., 2014; Paone, 2014). Many of these mixed methods interventions targeted professionals, caregivers, and others who interact with older adults, often in the form of training, education, program development, and other descriptive aspects of professional care (e.g., George, 2011; Lin, 2005; Ross et al., 2013; Smythe et al., 2014; Taylor, Barker, Hill, & Haines, 2015). Several studies included descriptive reflection and evaluation of intergenerational, student, and community volunteer programs (e.g., Denton et al., 2009; Kamei et al., 2011; Pesut et al., 2015; Phinney, Moody, & Small, 2014; Skropeta, Colvin, & Sladen, 2014). Others represented pilot tests of various interventions (e.g., Cristancho-Lacroix et al., 2015; Hooker et al., 2017; Lu, Haase, & Weaver, 2013; Moyle et al., 2014; Selman, Williams, & Simms, 2012).

Content Focus

As shown in Table 2, mixed methods studies in adult development and aging focused on a variety of topics. Content areas included technological advances in communication (e.g., Algilani, Langius-Eklöf, Kihlgren, & Blomberg, 2017; Doyle, Jackson, Loi, Malta, & Moore, 2016), respite care programs (e.g., Skilbeck et al., 2005; Theis, Moss, & Pearson, 1994), pain management (e.g., Kaasalainen et al., 2016; Richardson, Moore, Bernard, Jordan, & Sim, 2015), oral health promotion (e.g., Lewis, Kitson, & Harvey, 2016), exercise and physical therapy (e.g., Ellard, Thorogood, Underwood, Seale, & Taylor, 2014; Lee, 2012; Wardell, Decker, & Engebretson, 2012), and home visits for geriatric assessment (e.g., Stijnen, Jansen, Duimel-Peeters, & Vrijhoef, 2014).

Studies that were not tests of interventions often considered the progression of mental health and other key psychological or health conditions/transitions in older adults (e.g., Alter, 2016; DiGiacomo, Lewis, Nolan, Phillips, & Davidson, 2013; Nygren & Iwarsson, 2009; Salter et al., 2014; Wilhelm, Geerligs, & Peisah, 2014). For example, several mixed methods studies evaluated care for individuals with Alzheimer’s disease and related dementias and ways to decrease cognitive decline (e.g., Eekelaar, Camic, & Springham, 2012; Gustafsson, Svanberg, & Mullersdorf, 2015; Johnston et al., 2016; Moyle et al., 2014; Skropeta et al., 2014; Tak, Zhang, Patel, & Hong, 2015).

Other topics addressed by mixed methods studies in adult development and aging included depression (e.g., Barg et al., 2010; Dakin & Arean, 2013; Ellard et al., 2014; Izquierdo et al., 2015), long-term care admission (e.g., Afram et al., 2015; Ross, Rosenthal, & Dawson, 1997), pneumonia care (e.g., Hutt et al., 2011), evaluation of housing programs (e.g., Glass, 2013; Henwood, Katz, & Gilmer, 2015), retirement (e.g., Hobbis, 2012; Quine et al., 2007), and older adults’ interpersonal relationships (e.g., de Medeiros, Saunders, Doyle, Mosby, & Van Haitsma, 2012).

A smaller group of mixed methods studies focused on perceived well-being through community activities, such as the effects of a community-engaged arts program on physical, emotional, and social well-being (e.g., Phinney et al., 2014). Schell et al. (2016) investigated whether playing Wii Bowling (a digital game) could enhance the social life of older adults. The mixed methods enabled researchers to evaluate well-established quantitative outcomes (e.g., rigorous scales, indexes, tests, and measures) in addition to broader, self-defined themes pertaining to well-being that were captured in the qualitative data.

Design

Study designs were varied and included randomized trials (e.g., Huang et al., 2016), program evaluations (e.g., McCrae & Banerjee, 2011), long-term observational cohort studies (e.g., Richardson et al., 2015), and case studies (e.g., Warrick, Peckham, Watkins, Padjen, & Williams, 2014). Qualitative and quantitative methods were often employed at different time points. In intervention studies, most quantitative evaluations were conducted with a pre–post intervention design, and qualitative assessments were generally only conducted at post-intervention (i.e., sequential explanatory designs). In intervention studies, the timing of qualitative assessments was indicative of their purpose: Qualitative assessments in the initial phases of a study tended to inform the design and implementation of an intervention or program. In contrast, qualitative assessments following program implementation were generally used to help explain findings.

Researchers reporting mixed methods studies in adult development and aging rarely if ever identified their mixed methods design type, nor did they use recommended notation when describing their mixed methods designs. Most mixed methods studies in adult development and aging took the form of sequential explanatory designs (where a qualitative component follows a quantitative component; n = 81) or were variations on parallel convergent mixed methods designs where quantitative and qualitative data were collected concurrently at various waves of data collection (n = 125). The point of integration of almost all mixed methods studies in adult development and aging occurred in the Results section, where the findings of the quantitative and qualitative data were compared (although sometimes such comparisons were conducted loosely and findings from the two strands were not fully integrated).

Methodological details were often lacking, including exact time points of sampling, participant selection, and study location. In general, the method of selecting participants for qualitative assessments was unclear, and sample sizes, especially for studies employing focus groups, were poorly documented. For several studies, the unit of analysis for the quantitative component differed from the unit of analysis for the qualitative component. The merging of qualitative and quantitative studies was often poorly described and had to be inferred from the reporting in the Results sections of articles. The exception to this was when qualitative assessments were used to inform the development of an intervention or program, during which qualitative data were used to justify and populate various components of the intervention (e.g., Auger et al., 2015).

There were several other exceptions that illustrated more advanced approaches to mixing quantitative and qualitative data, such as using quantitative results from an earlier phase to select particular participants for qualitative interviews (e.g., Lee, 2012; Richardson et al., 2015). For example, in a 2-year study of medication adherence among older women at risk of hip fracture, Salter and colleagues (2014) used risk of fracture scores collected in the initial quantitative strand to identify a qualitative subsample. Similar approaches to qualitative sample selection were used by Richardson et al. (2015) in a 6-year study of adaptation to musculoskeletal pain. Wenger and Burholt (2004) used measures of loneliness and social isolation collected over a 20-year period to identify cases that featured both qualitative and quantitative data. Barg et al. (2010) used 6-month change in depression group status (quantitative) to synthesize available qualitative data on patient perspectives of the benefits of depression treatment. Lofqvist and colleagues (2009) purposively selected participants for in-depth interviews on their use of mobility devices, using existing quantitative data that had been collected for a larger longitudinal study. Ingersoll-Dayton et al. (2004) integrated four stages of staggered qualitative and quantitative methods (individual and focus group interviews, a preliminary survey, cognitive interviews, and a second survey) to develop a measure of psychological well-being based on the indigenous expertise of Thai elders. This example is one of the few that occurred in a non-Western context. Auger and colleagues (2015) conducted a two-phase study to inform the development (Phase I) and feasibility (Phase II) of an automated call monitoring intervention for older wheelchair users. Phase I consisted of designing a questionnaire to identify the call monitoring system and qualitative evaluation of the questionnaire to assess face validity. In Phase II, following completion of the intervention (cohort design), the authors conducted a qualitative assessment to evaluate users’ experiences to assess the feasibility of the monitoring intervention.

Gaps

There were several consistent gaps and limitations in existing mixed methods studies in adult development and aging. Existing mixed methods studies tended to not specify whether the quantitative and qualitative components were prioritized, or which study strand “drove” the analysis. For these reasons, the authors of this article rated the driving strand based on their interpretation of each selected study’s research design description. In general, the quantitative components of the mixed methods studies appeared to drive the overall study design. However, with several exceptions (e.g., Dossa & Capitman, 2010; Ellard et al., 2014; Henwood et al., 2015; Hutt et al., 2011; Izquierdo et al., 2015; Quine et al., 2007; Richardson et al., 2015; Wenger & Burholt, 2004), the mixed methods studies available tended to feature small samples.

In general, the majority of longitudinal mixed methods studies in adult development and aging are program evaluations serving as pilot studies and are not powered or designed to determine efficacy nor effectiveness. Similarly, adequate sampling rationales for both qualitative and quantitative components were not well described, especially when multiple time points of data collection (as in longitudinal studies) were featured. Pre-/post-program evaluations and intervention studies did not achieve the full potential of longitudinal research to gather repeated observations of the same variables over longer periods of time. Moreover, due in part to the limited samples featured, mixed methods studies in adult development and aging tend to not feature robust longitudinal analyses or inference. A substantial percentage (n = 37 articles focused on professionals/volunteers, and an additional n = 5 articles focused on family/informal caregivers) of mixed methods studies in adult development and aging focused on care professionals, nursing/medical students, intergenerational volunteers, or others providing formal or informal assistance to older adults, rather than focusing on older persons themselves. Some studies included large numbers of older adults due to the focus on a specific medical condition, such as dementia, palliative care, hip fractures, chronic obstructive pulmonary disease, or cancer, but aging was not these studies’ primary focus. Few studies incorporated perspectives of older adults’ experiences of aging over time (e.g., quality of life in independent and institutional residential settings, experiences of transitioning into retirement, and navigation and psychological impacts of interpersonal relationships in later life given the death of family and friends). For these reasons, it could be argued that mixed methods have not been fully employed to study adult developmental and aging processes in depth.

The number of mixed methods studies in adult development and aging have grown substantially since 2006, perhaps coinciding with an increase in the number of methodological texts and more formal instruction as to how to conduct mixed methods (Andrew & Halcomb, 2009; Creswell & Plano Clark, 2010; Morse & Niehaus, 2009; Tashakkori & Teddlie, 2010). The majority of mixed methods studies were conducted in Western countries, such as the United States (e.g., Hutt et al., 2010; Mullaney, Devereaux Melillo, Lee, & MacArthur, 2016; Riebe, Fan, Unutzer, & Vannoy, 2012; Schonberg, Birdwell et al., 2014), Canada (e.g., Pesut et al., 2015; Phinney et al., 2014; Porter & Tuokko, 2011), the United Kingdom (e.g., Eekelaar et al., 2012; Gell, 2013; Morgan-Brown, 2013), and Australia (e.g., Blackford & Street, 2012; Haas, Mason, & Haines, 2014; Lea et al., 2015). Mainland European examples include Denmark (e.g., Hammer, Bieler, Beyer, & Midtgaard, 2016; Lofqvist et al., 2009), Germany (e.g., Brand et al., 2016; Quasdorf et al., 2017), and the Netherlands (e.g., Stijnen et al., 2014). Few studies involved data collection in non-Western settings (notable exceptions include Ingersoll-Dayton et al., 2004 in Thailand). However, the search was limited to articles published in English, so there is an inherent bias in our sample that could have precluded studies that took place in non-Western study contexts. Furthermore, the extent to which these studies included marginalized and minority populations is unclear. Several studies (n = 17) did not report demographics at all (e.g., Braude et al., 2015), or did not indicate race, ethnicity, or nationality among the participants’ characteristics (n = 41; e.g., Hasemann et al., 2016; Hedley, Suckley, Robinson, & Dawson, 2010; Kaasalainen et al., 2016). Others report samples that include very small proportions of ethnic minority participants (e.g., Dossa & Capitman, 2010). In general, it seems that the role of race, ethnicity, and other cultural factors is not frequently considered in mixed methods studies, which is a lost opportunity given the potential of mixed methods studies to further explore key phenomena in culturally diverse contexts (Mertens, 2007).

Other methodological concerns included how qualitative data were deployed. Longitudinal qualitative data were rarely administered. Instead, qualitative data were collected from focus groups or interviews of a subsample of participants at a single time point following longitudinal collection of quantitative data. For example, Gell (2013) used the English Longitudinal Study of Ageing (5,892 adults aged 50+, sampled over 50 years), but the qualitative sample was limited to 19 individuals interviewed at a single time point. Some retrospective interviews appeared to feature multiple data points, but these often were excluded from our review because they involved a single interview that reflected on multiple past events. Such approaches may limit the ability of investigators to discern trends in qualitative data alongside quantitative data elements.

This initial review of mixed methods research in adult development and aging also suggests that much of the existing literature in this area demonstrates limited “mixing,” if any at all. Most of the integration of qualitative and quantitative data occurred in Results sections, but efforts to demonstrate concordance or divergence between multiple data strands were limited. In some instances, the point of interface in these mixed methods designs occurred in the sampling procedure (e.g., using quantitative findings to identify a subsample for qualitative data collection), but such studies were few.

Discussion

Although growing, the use of mixed methods in adult development and aging science remains limited. Mixed methods represents an underutilized methodology that can help to advance understanding of the mechanisms of interventions and phenomena pertaining to aging processes. Many interventions delivered to older adults are complex (e.g., a psychosocial dementia caregiving intervention). Even interventions that appear simple (e.g., taking a statin) operate within the context of complex socioeconomic dynamics. Although quantitative data provide effect-sizes, the methods of achieving effects are often unclear. Equally important is understanding when or why treatments do not work. Sometimes the reason an intervention does not work is not because the treatment is ineffective, but because of other factors (e.g., participant challenges related to transportation to study sites; misunderstanding of study procedures). This is the type of contextual data that quantitative data alone is often unable to provide. Further, such contextual data can provide valuable insight to improve intervention implementation. Mixed methods studies are also important to help inform the development of interventions. Focus groups combined with quantitative evaluations during the development stage of an intervention can be powerful when enhancing sampling, refining the consent process, and identifying more effective enrollment approaches in addition to highlighting potential areas of intervention content, structure, and mode of delivery.

In our review of the literature, most studies employed mixed methods designs during a single project phase—either during intervention development or as part of a program evaluation. Furthermore, within mixed methods studies, quantitative data were collected at multiple time points, but qualitative assessments were generally only conducted at the beginning or end of the study. To tap into the true power of mixed methods designs, studies in adult development and aging require ongoing integration of data collection throughout the research process. Mixed methods studies should not only be used early on to help inform the development of interventions, but also during intervention delivery to provide contextual data to understand efficacy trial results and later to explain the processes that led to the results. For such designs, it is often insufficient to conduct qualitative data collection at only a single time point.

A host of non-interventional mixed methods studies were identified that sought to explain various types of experiences or phenomena (e.g., bereavement following the death of a spouse). These studies have great potential to supplement quantitative cohort data. Moving forward, cohort mixed methods studies in adult development and aging should adopt a more rigorous approach based on well-established qualitative research methods. One particular area for improvement is more clearly defined methods of selecting respondents to participate in qualitative assessments in mixed methods designs.

An important methodological detail missing was study context. Both interventional and non-interventional studies rarely included the geographic location of data collection and participant sampling. As mentioned previously, interventions and observational studies do not occur in a vacuum. A treatment may not be effective due to exterior geographic conditions, such as inadequate transportation for participants to the study site or inclement weather conditions. The built and natural environments figure importantly in the lives and experiences of older adults and their caregivers. Person–place interactions have important implications for health and well-being in later life, especially as older adults tend to become less mobile and spend more time in specific locales. Longitudinal mixed methods research on aging has an opportunity to incorporate and examine the situatedness of study variables and observed phenomena. This begins by simply stating the paper’s geographic context in the Methods section. Maps can be helpful additions to orient readers. Geographic information systems (GIS) are underutilized to date in this area of research and could provide informative geospatial information when productively paired with quantitative and qualitative research. Studies could make geographic context an explicit focus, such as contrasting an urban/suburban case study area to a rural case study area over time. International comparisons are also needed to investigate interventions and observations across global aging populations.

Similarly, longitudinal mixed methods can help improve understanding of older adult health outcomes by exploring changing contextual cognitive processes and physical/social environments, rather than relying on quantitative diagnoses (e.g., numeric values assigned to cognitive decline). Longitudinal mixed methods can also help improve working and caregiving relationships by giving voice to the experiences of both the older adult and caregivers/health professionals. In this way, the adult development and aging literature can strive to better understand the context of components in healthy working relationships and thus have more specific targets for intervention and training development.

Few studies explicitly address cultural factors that may be important when understanding the effects of interventions and other phenomena under study. Most of the research reviewed took place in Western nations, and many of these studies do not consider race or ethnicity as potentially meaningful factors that may affect the generalizability of their results. This is problematic because existing research suggests that marginalized groups may have substantially different aging experiences than Western, Caucasian individuals of higher socioeconomic status. For instance, older adults from ethnic and racial minority backgrounds have poorer self-rated health than white individuals (Min, Rhee, Lee, Rhee, & Tran, 2014) and have comparatively delayed access to healthcare (Du & Xu, 2016). Furthermore, immigrants report poorer self-rated physical (Heron, Schoeni, & Morales, 2003) and mental health than non-immigrants (Kim, Auh, Lee, & Ahn, 2013). Mixed methods research offers a potential opportunity to address some of these gaps in the literature and the larger health disparities that exist in adult development and aging.

Many qualitative methods are geared toward fostering community engagement, and some have direct roots in social justice work aimed at identifying and meeting the needs of a marginalized community (e.g., Participatory Action Research; Kidd & Kral, 2005). Engaging participants in direct, personal communication through use of qualitative components can build rapport and relationships with the community studied and also help guide subsequent quantitative research design, data collection, and analysis more effectively. For example, using a sequential design that begins with a qualitative component could allow researchers to gather information that may counter their assumptions and shape subsequent quantitative data collection to better suit the population under study.

Our overview of the state of the science suggests several additional recommendations to maximize the use of mixed methods in adult development and aging. One particular issue that is apparent is that almost all of the studies identified do not provide sufficient or clear detail on the overall mixed methods design selected or the point of interface/integration between qualitative and quantitative strands. A recommendation to address this gap is the use of diagrams that map out the often complex design characteristics of mixed methods studies. This helps to clarify, in visual fashion, the various quantitative and qualitative components of a given mixed methods study, their points of interface, and the expected analytic “products.”

Mixed Methods Research in Adult Development and AgingClick to view larger

Figure 2. Example of a diagram depicting the timing, integration, data components, and analytic approach of a mixed methods study (Mitchell et al., 2018).

Mixed Methods Research in Adult Development and AgingClick to view larger

Figure 3. Example of a diagram depicting the procedure, point of interface, and products of a multiphase mixed methods study (Gaugler, 2014).

Mixed Methods Research in Adult Development and AgingClick to view larger

Figure 4. Diagram of an embedded experimental mixed methods design.

Several figures are provided from recent work to illustrate how diagrams can serve as powerful illustrations of various types of longitudinal mixed methods design. For example, a one study from this research team evaluated the feasibility and utility of an in-home remote activity monitoring (RAM) technology for 30 family caregivers of persons with Alzheimer’s disease and related dementias. The authors collected quantitative survey data over a 6-month period and qualitative survey and interview data every 6 months for up to 18 months. A parallel convergent mixed methods design was employed. The diagram in Figure 2 demonstrates the timing, integration, data components, and analytic approach (Mitchell et al., 2018). The authors also used a multiphase, sequential exploratory design to develop new measures of the process of adult day service use for older adults. Specifically, qualitative data (Gaugler, 2014) were first collected to help develop potential items, subdimensions, and measures. This qualitative work served as the basis for creating items, subscales, and quantitative measures of adult day service use that were tested using classic psychometric methods as shown in Figure 3. As a third example, the research team is currently conducting a randomized controlled evaluation of psychosocial intervention for family members of cognitively impaired relatives who live in residential care (R01AG048931). Families are followed for a year in this embedded experimental evaluation, with qualitative data collected during the course of the intervention and following a 12-month survey (see Figure 4).

Even if diagrams of mixed methods studies are considered too cumbersome or space considerations do not allow for such illustration, more consistent use of mixed methods notation to better describe the timing, sequence, and prioritization of study components would greatly advance current descriptions of longitudinal mixed methods studies. Although these tools have been available for some time to better highlight and describe key components of mixed methods designs, they have not emerged consistently in the adult development and aging literature to date.

Another current limitation is the lack of advanced mixed methods analyses. While one could argue that quantitative methods in adult development and aging are among the state-of-the-art, the same cannot be said for mixed methods. Almost uniformly, mixed methods analyses are relegated to comparisons of qualitative and quantitative data that are analyzed separately in Results sections with varying degrees of success (see the section “Design”). Other developmental psychologists have demonstrated more advanced approaches that could capitalize on multiple longitudinal methods, where longitudinal qualitative data are “quantified” and incorporated into quantitative longitudinal analyses. For example, Syed (2010) and Syed and Azmitia (2008) conducted longitudinal qualitative interviews with diverse young adults in college to study identity trajectories. These interviews were then coded numerically and utilized in sophisticated longitudinal analyses. There were several instances in the studies reviewed here where more advanced use of mixing occurred (for example, when quantitative findings were used to inform the sampling approach for a subsequent qualitative component). However, for the most part, the integration and analysis of mixed methods data to date are simplistic.

Conclusion

Our systematic review spanning 172 articles published between 1994 and 2017 shows that greater adoption of mixed methods research practices (e.g., design description, point of integration, analytic approaches) is needed to more fully realize the potential of this methodology in adult development and aging research. We argue that mixed methods are currently viewed as approaches more suitable for preliminary scientific efforts and that adult development and aging has adopted a limited practice and methodological scope pertaining to mixed methods. Fully incorporating qualitative data across measurement points, applying mixed methods to understand development in context, extending and strengthening points of interface, and using more refined reporting would enhance the quality of mixed methods studies in adult development and aging.

O’Cathain (2010) suggests a comprehensive framework to assess the quality of mixed methods research and pursue best practices. First, in the planning stage, researchers are advised to critically consider the study’s foundations that shape the research question and methods, justify using a mixed methods approach, give clear details regarding data collection and analysis, and ensure that each component is feasible (e.g., time, money, personnel resources). Second, rigorous study design involves a transparent mixed methods typology, suitable and appropriate methods, consideration of the strengths and weaknesses of each method employed to minimize bias and optimize breadth and depth, and rigorous implementation that stays true to the design. Third, high-quality data products require that each method is described in sufficient detail, methods are implemented with rigor, the sampling technique and sample size for each method are adequate, appropriate data analysis techniques are undertaken, and any integration of data analyses are robust. Fourth, resulting interpretations and conclusions should be based on transparent interpretations (i.e., it is clear which findings emerged from which methods) and inferences drawn should be consistent with the findings and current knowledge/theory. Others should be able to reach consistent conclusions based on the findings presented. Explanations should be given for any inconsistencies between findings and inferences, and inferences should correspond to the overall purpose of the study. A study’s conclusions are ideally transferable to other contexts and settings, groups and individuals, the future, and other methods. Fifth, rigorous dissemination involves transparent reporting of the study’s key aspects. Findings are ideally used by consumers and policymakers.

The phenomena that we study in adult development and aging are remarkably complex and require methodological tools to describe and explain this complexity. Mixed methods, if conducted with adherence to the fairly well-developed set of guidelines and recommendations offered in this article, are well suited to advance adult development and aging science.

Table 2. Mixed Methods Studies in Adult Development and Aging Reviewed (n = 172)

Citation

Study Objective & Results

Sample Size1

Follow-up Time

Quan Outcomes

Method Design2

Interface Point

Afram, B., Verbeek, H., Bleijlevens, M. H., Challis, D., Leino-Kilpi, H., Karlsson, S., . . . RightTimePlaceCare Consortium (2015). Predicting institutional long-term care admission in dementia: A mixed-methods study of informal caregivers’ reports. Journal of Advanced Nursing, 71(6), 1351–1362.

To investigate expected vs. actual reasons for admission of people with dementia according to informal caregivers, and compare cognitive scores prior to admission vs. actual reasons for admission according to informal caregivers

126 dyads of persons with dementia and informal caregivers (252 total)

3 months

Cognitive status, neuropsychiatric symptoms, functional status, and comorbidity of person with dementia; caregiver burden for informal caregiver

qual + quan*

Results

Algilani, S., Langius-Eklöf, A., Kihlgren, A., & Blomberg, K. (2017). An interactive ICT platform for early assessment and management of patient-reported concerns among older adults living in ordinary housing: Development and feasibility. Journal of Clinical Nursing, 26(11/12), 1575–1583.

To create and test an interactive, tablet-based platform for reporting and managing health concerns of older adults receiving care at home. The application was generally well received, and facilitated communication between care recipients and home care nurses.

8 older adults and 3 RNs

4 weeks

Logged health concerns (e.g., pain, fatigue, dimness, loss of appetite, fever, diarrhea)

quan (12x) → QUAL* (ongoing quantitative assessment, at least 12x over 4 weeks, followed by qual assessment)

Results

Allen, R. S., Harris, G. M., Burgio, L. D., Azuero, C. B., Miller, L. A., Shin, H. J., . . . Parmelee, P. (2014). Can senior volunteers deliver reminiscence and creative activity interventions? Results of the legacy intervention family enactment randomized controlled trial. Journal of Pain and Symptom Management, 48(4), 590–601.

To conduct a randomized controlled trial examining the effectiveness of retired senior volunteers (RSVs) in delivering a reminiscence and creative activity intervention aimed at alleviating palliative care patient and caregiver distress

45 dyads

20 weeks

Positive and Negative Affect Schedule (PANAS); Center for Epidemiological StudiesDepression Scale (CESD)

QUAL + quan*

Results

Annear, M. J., Lea, E., Lo, A., Tierney, L., & Robinson, A.(2016). Encountering aged care: A mixed methods investigation of medical students’ clinical placement experiences. BMC Geriatrics, 16, 38.

To explore the effects of clinical placements at long-term care facilities on medical students’ attitudes toward working with older adults, and relevant knowledge and skills. Preplacement, students showed good dementia knowledge but poor attitudes toward working with older adults; these attitudes improved following placement.

61 medical students

5 days

Surveys of dementia knowledge and questions about attitudes to the aged care sector and working with older adults.

QUAN → QUAN → QUAL* (quan pre and post surveys, plus qual interview at the end)

Results

Auger, C., Miller, W. C., Jutai, J. W., & Tamblyn, R.(2015). Development and feasibility of an automated call monitoring intervention for older wheelchair users: The MOvIT project. BMC Health Services Research, 15, 386.

To explore the use of automated calls for the monitoring of adverse events associated with wheelchair use. Most users found the monitoring tool useful and intended to use it in the future.

Phase I (development/validation of the tool): 12 wheelchair users; Phase II (feasibility study): 71 wheelchair users

Phase I: cross-sectional; Phase II: 3 months

Adverse outcomes

Phase I: QUAL priority; Phase II:QUAN + QUAL

Results

Barg, F. K., Mavandadi, S., Givens, J. L., Knott, K., Zubritsky, C., & Oslin, D. W.(2010). When late-life depression improves: What do older patients say about their treatment?American Journal of Geriatric Psychiatry, 18(7), 596–605.

From the patient perspective, understand the benefits of depression treatment. Social aspects of participating in treatment were identified as the most beneficial component of depression treatment.

24 depressed older adults

6 months

Depression status

QUAN + QUAL* (or, QUAN → QUAN + QUAL)

Sample selection/Data analysis: Used change in depression status and identified open-ended comments within each group.

Beck, S. L., Towsley, G. L., Caserta, M. S., Lindau, K., & Dudley, W. N.(2009). Symptom experiences and quality of life of rural and urban older adult cancer survivors. Cancer Nursing, 32(5), 359–369.

To examine the symptom experience, health-related quality of life, and functional performance of elderly cancer survivors at 1 and 3 months after the completion of initial treatment. There was minimal improvement 3 months after treatment

52 older adult cancer survivors

2 months

Symptom experience, health-related quality of life, functional performance

QUAN → QUAN + qual*

Results

Bentley, M., Minstrell, M., Bucher, H., Sproule, L., Robinson, A., & Stirling, C.(2015). Aged care nurse practitioners working in general practice. Journal of Clinical Nursing, 24(23/24), 3745–3747.

To describe implementation process of a geriatric nurse practitioner within a general practice setting. The findings suggested this was achieved in part and could hold clinical potential.

2 nurse practitioners, 168 clients quan only

25 months

Demographic and clinical characteristics of clients

quan + QUAL* (throughout 25-month observation period)

Results

Berry, K., Purandare, N., Drake, R., Elmsley, R., Jones, L., & Barrowclough, C.(2014). A mixed-methods evaluation of a pilot psychosocial intervention group for older people with schizophrenia. Behavioural and Cognitive Psychotherapy, 42(2), 199–210.

A pilot psychosocial intervention for older adults with schizophrenia. Participants improved in measured self-esteem and experienced reductions in negative symptoms.

7 older adults with schizophrenia

Within 1 month of last session

Self-esteem, hopelessness, symptoms, depression, social behavior, independent living

QUAN + QUAL

Results

Blackford, J., & Street, A.(2012). Is an advance care planning model feasible in community palliative care? A multi-site action research approach. Journal of Advanced Nursing, 68(9), 2021–2033.

To determine the feasibility of an advance care planning model developed with Australian community palliative care services

9 staff and clients

16 months

Conducted audit of staff and clients; analyzed client records, policies, procedures, and quality improvement strategies both pre-implementation and post-implementation.

quan → quan + qual*

Results

Bleijenberg, N., Ten Dam, V. H., Drubbel, I., Numans, M. E., de Wit, N. J., & Schuurmans, M. J.(2016). Treatment fidelity of an evidence-based nurse-led intervention in a proactive primary care program for older people. Worldviews on Evidence-Based Nursing, 13(1), 75–84.

To explore provider views about a program designed to improve care for frail older adults. Barriers to implementing the program include lack of time and financial compensation.

32 general practitioners and 21 practice nurses

12 months

Barriers, limitations, needs, expectations, and experiences

QUAN → qual

Results

Bleijenberg, N., Ten Dam, V. H., Steunenberg, B., Drubbel, I., Numans, M. E., De Wit, N. J., & Schuurmans, M. J.(2013). Exploring the expectations, needs and experiences of general practitioners and nurses towards a proactive and structured care programme for frail older patients: A mixed-methods study. Journal of Advanced Nursing, 69(10), 2262–2273.

To examine treatment fidelity in a large frailty intervention trial. All components were delivered as intended, although type and dosage of nursing care varied by condition of older participants.

N of nurses in focus group not reported; 835 older adults quan only

Not reported

Number, type, and dosage of nursing interventions

QUAN → qual*

Results

Bleijlevens, M. H., Gulpers, M. J., Capezuti, E., van Rossum, E., & Hamers, J. P.(2013). Process evaluation of a multicomponent intervention program (EXBELT) to reduce belt restraints in nursing homes. Journal of the American Medical Directors Association, 14(8), 599–604.

Process evaluation of belt restraint reduction program in nursing home residents; the program largely performed according to its protocol.

143 nursing home staff; 38 relatives of nursing home residents; others

9 months

Exposure, satisfaction, reach

QUAN + qual (at different points)

Results

Blusi, M., Dalin, R., & Jong, M.(2014). The benefits of e-health support for older family caregivers in rural areas. Journal of Telemedicine and Telecare, 20(2), 63–69.

A pragmatic, mixed methods study to compare rural family caregivers receiving e-health caregiver support with a control group receiving conventional, non-e-health caregiver support

56 (quan); 33 (qual)

18 months

In all domains the e-health group scored significantly higher than the control group. The adjusted difference for overall benefits was 3.0 (P = 0.02) on the scale 0–10.

QUAN(qual)*

Results

Bormann, J., Warren, K. A., Regalbuto, L., Glaser, D., Kelly, A., Schnack, J., & Hinton, L.(2009). A spiritually based caregiver intervention with telephone delivery for family caregivers of veterans with dementia. Family & Community Health, 32(4), 345–353.

Tested the efficacy of a spiritually based mantra caregiver intervention using teleconference calls. Caregiver burden, perceived stress, rumination, and depression were reduced; quality of life was improved.

16 caregivers

3-time repeated-measures design with 36-week follow-up telephone interviews

Caregiver burden, perceived stress, depression, rumination, quality of life enjoyment and satisfaction

QUAN → QUAN → QUAN → qual*

Results

Brand, G., Osborne, A., Carroll, M., Carr, S. E., & Etherton-Beer, C.(2016). Do photographs, older adults’ narratives and collaborative dialogue foster anticipatory reflection (“preflection”) in medical students?BMC Medical Education, 16(1), 289.

To explore whether photographs, narratives, and small group collaborative dialogue fosters reflective learning, enhances reflective capacity, and has the potential to shift medical students’ attitudes toward caring for older adults

128 second-year medical students

Pre and post 4-week geriatric medicine clinical placement

The DOF session generated reflective learning that resulted in positive shifts in medical students’ perceptions toward older adults.

quan + qual → quan + qual*

Results

Braude, P., Reedy, G., Dasgupta, D., Dimmock, V., Jaye, P., & Birns, J.(2015). Evaluation of a simulation training programme for geriatric medicine. Age and Ageing, 44(4), 677–682.

To evaluate a training program involving simulated geriatric care for medical students training to work with older adults. Participants’ confidence with managing geriatric cases increased over the course of the intervention, and participants found the training valuable.

89 medical students

1 day (same day?): pre- and post-questionnaire for a single-day course

Self-confidence in several domains (e.g., emergency management, communication)

(QUAL + quan) → (QUAL + quan)*

Results

Bull, M. J., Boaz, L., Maadooliat, M., Hagle, M. E., Gettrust, L., Greene, M. T., . . . Saczynski, J. S.(2017). Preparing family caregivers to recognize delirium symptoms in older adults after elective hip or knee arthroplasty. Journal of the American Geriatrics Society, 65(1), e13–e17.

To test the feasibility of a phone-based intervention that prepares family caregivers to recognize delirium symptoms and how to communicate their observations to healthcare providers

34 completed the intervention family caregiver–older adult dyads.

2 months

Confusion Assessment Method (CAM); Family Version of the Confusion Assessment Method (FAM-CAM)

QUAL → quan*

Results

Butler, S. S., Brennan-Ing, M., Wardamasky, S., & Ashley, A. (2014). Determinants of longer job tenure among home care aides: What makes some stay on the job while others leave?Journal of Applied Gerontology, 33(2), 164–188.

Explored determinants of job tenure for home care aides; various quantitative predictors and themes provided related to tenure.

59 long-stay and short-stay home care aides, 261 home care aides quan only

18 months

Length of employment

QUAN → qual (QUAN → QUAN → qual)

Results

Camic, P. M., Tischler, V., & Pearman, C. H.(2014). Viewing and making art together: A multi-session art-gallery-based intervention for people with dementia and their carers. Aging & Mental Health, 18(2), 161–168.

To understand the experience of an 8-week art-gallery-based intervention offered at two distinctly different galleries for people with mild to moderate dementia and their carers. The study examined impact on social inclusion, carer burden, and quality of life and daily living activities for a person with dementia.

24 participants,12 with dementia

8 weeks

Standardized questionnaires related to social inclusion, carer burden, and quality of life and daily living activities

QUAL + quan*

Results

Carmody, J., Potter, J., Lewis, K., Bhargava, S., Traynor, V., & Iverson, D.(2014). Development and pilot testing of a decision aid for drivers with dementia. BMC Medical Informatics and Decision Making, 14, 19.

Pilot to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia.

12 older adults with dementia

Unspecified—telephone surveys conducted before and after participants read the decision aid

The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use, and booklet acceptability were the secondary outcome measures.

QUAL → QUAL + quan*

Results

Cartwright, J., Franklin, D., Forman, D., & Freegard, H.(2015). Promoting collaborative dementia care via online interprofessional education. Australasian Journal on Ageing, 34(2), 88–94.

To test an online training module aimed at improving collaboration among health professionals in different roles through a dementia case study. The module was successful in promoting collaboration and interprofessional capabilities among participating students.

125 quan, 65 qual health professional students

4 weeks

Survey of interprofessional beliefs, behaviors, and attitudes

QUAN → QUAN → QUAL* (quan pre and post surveys, plus qual interview at the end)

Results

Chapin, R. K., Sergeant, J. F., Landry, S. T., Koenig, T., Leiste, M., & Reynolds, K.(2010). Hoarding cases involving older adults: The transition from a private matter to the public sector. Journal of Gerontological Social Work, 53(8), 723–742.

To understand the progression of hoarding cases of older adults

52 case files (quan and qual), 42 professionals (qual)

Up to 3 years

Residential outcome, others

(QUAL + quan) + qual

Methods and data analysis (case analysis)

Cristancho-Lacroix, V., Wrobel, J., Cantegreil-Kallen, I., Dub, T., Rouquette, A., & Rigaud, A. S.(2015). A web-based psychoeducational program for informal caregivers of patients with Alzheimer’s disease: A pilot randomized controlled trial. Journal of Medical Internet Research, 17(5), e117.

Pilot RCT to evaluate the efficacy and acceptability of a web-based psychoeducational program for informal caregivers of persons with Alzheimer’s disease.

49 caregivers of persons with Alzheimer’s disease

Baseline, at the end of the program (3-month), and after follow-up (6-month); semi-structured interviews with experimental group at month 6

Caregivers’ perceived stress (PSS-14, primary outcome), self-efficacy, burden, perceived health status, and depression (secondary outcomes) were measured during 3 face-to-face on-site visits.

QUAN → QUAN → QUAN + qual*

Results

Dakin, E. K., & Arean, P.(2013). Patient perspectives on the benefits of psychotherapy for late-life depression. American Journal of Geriatric Psychiatry, 21(2), 155–163.

The identified common reasons for seeking psychotherapy were depression and related interpersonal relationships, health conditions, grief/loss, finances, housing, and cognitive dysfunction. Participants had few expectations of therapy but wanted to have general support and to focus on problem solving and interpersonal relationships.

22 older adults with depression

Anywhere between week 12 (last week of treatment) and 9-month follow-up

Quantizing the percentage of reasons for seeking treatment and expectation level of treatment

QUAN → QUAN → qual → QUAN*

Results

Danilovich, M. K., Hughes, S. L., Corcos, D. M., Marquez, D. X., & Eisenstein, A. R.(2017). Translating Strong for Life into the Community Care Program: Lessons learned. Journal of Applied Gerontology, 36(5), 553–569.

RCT to test the implementation of Strong for Life, a resistance exercise intervention

32 home care aides as exercise leaders with their 42 homebound older adult clients

12 weeks

Mixed methods were used to analyze outcomes of program satisfaction rates, training session evaluations, program fidelity, and job descriptive index scores

QUAN + qual*

Results

Danoff-Burg, S., & Revenson, T. A.(2005). Benefit-finding among patients with rheumatoid arthritis: Positive effects on interpersonal relationships. Journal of Behavioral Medicine, 28(1), 91–103.

Positive effects of illness include appreciating support received from loved ones and lower levels of perceived pain, distress, and social constraints. Only interpersonal benefits predicted lower levels of disability at a 12-month follow-up.

158 (quan); 136 (quan) care recipients

12 months

Percentage of kind of benefits experienced (relationship, other, none)

QUAN(qual) → quan*

Sample selection/Data analysis: Discriminant function analysis to determine which patient factors were associated with benefits

Dattalo, M., Wise, M., Ford, J., II, Abramson, B., & Mahoney, J.(2017). Essential resources for implementation and sustainability of evidence-based health promotion programs: A mixed methods multi-site case study. Journal of Community Health, 42(2), 358–368.

Identify strategies to facilitate program expansion and sustainability of health promotion programs for older adults in rural areas. Identified 6 essential resources to be successful, leading to more workshops.

57 sources from 8 sites

3 years

Number of workshops, funding levels

quan(QUAL) → quan(QUAL) → quan(QUAL)*

Results

Denton, G. D., Rodriguez, R., Hemmer, P. A., Harder, J., Short, P., & Hanson, J. L.(2009). A prospective controlled trial of the influence of a geriatrics home visit program on medical student knowledge, skills, and attitudes towards care of the elderly. Journal of General Internal Medicine, 24(5), 599–605.

To determine the impact of a geriatrics home visit program for third-year medical students on attitudes, skills, and knowledge

33 third-year medical students

6 weeks

Pre- and post-test attitudinal self-reports of perspectives of attitudes toward older adults

QUAN + QUAL*

Results

DiGiacomo, M., Lewis, J., Nolan, M. T., Phillips, J., & Davidson, P. M.(2013). Health transitions in recently widowed older women: A mixed methods study. BMC Health Services Research, 13, 143.

To understand the experiences and needs of older women following the death of a partner. The findings suggested new health challenges for widows following this transition.

21 bereaved older women

12 months

Negative mental health, general health, chronic conditions

QUAL + quan (at 3 time points)*

Results

Dimond, M., Caserta, M., & Lund, D.(1994). Understanding depression in bereaved older adults. Clinical Nursing Research, 3(3), 253–268.

To explore depressive symptoms among bereaving spouses. Depressed spouses were more likely to report illness, deaths of family/friends, and changes in interpersonal relationships.

192 (quan); 10 (qual) bereaved older adults

2 years

Depression

QUAN + QUAL

Results

Dingwall, L., Fenton, J., Kelly, T. B., & Lee, J.(2017). Sliding doors: Did drama-based inter-professional education improve the tensions round person-centred nursing and social care delivery for people with dementia: A mixed method exploratory study. Nurse Education Today, 51, 1–7.

To evaluate an educational intervention to promote person-centered health and social care and to determine if the intervention impacts student attitudes. Social work students appear to be more person centered than nursing students.

63 students

8 weeks

Learning-based outcomes

QUAN + QUAL

Results

Dionigi, R.(2007). Resistance training and older adults’ beliefs about psychological benefits: The importance of self-efficacy and social interaction. Journal of Sport and Exercise Psychology, 29(6), 723–746.

To determine the perceived psychological benefits and explore the mechanisms underlying the link between exercise and psychological well-being for a group of older adults

10 older adults

12 weeks

Results of resistance training

QUAN + qual*

Results

Dossa, A., & Capitman, J. A.(2010). Community-based disability prevention programs for elders: Predictors of program completion. Journal of Gerontological Social Work, 53(3), 235–250.

To explore possible reasons why older adults do not complete health promotion programs. High client self-efficacy and higher focus on provider–client relationships increased the likelihood of completing programs, whereas minority status decreased likelihood of completion.

719 clients (quan); 20 nurses, 23 social workers, 18 site managers (qual)

2 years (secondary longitudinal data)

Program completion

QUAN → QUAN → QUAN → qual

Results

Doyle, C., Jackson, D., Loi, S., Malta, S., & Moore, K.(2016). Videoconferencing and telementoring about dementia care: Evaluation of a pilot model for sharing scarce old age psychiatry resources. International Psychogeriatrics, 28(9), 1567–1574.

To evaluate a videoconferencing peer support intervention designed to improve communication and supervision among psychiatry staff in rural and remote areas. The program decreased perceived stress and improved performance of clinicians.

18 staff

14 months

Survey evaluating the educational materials

(QUAL + quan) → (QUAL + quan) → (QUAL + quan) → QUAL*

Results

Drennan, V., Iliffe, S., Haworth, D., Tai, S. S., Lenihan, P., & Deave, T.(2005). The feasibility and acceptability of a specialist health and social care team for the promotion of health and independence in “at risk” older adults. Health & Social Care in the Community, 13(2), 136–144.

To describe the evaluation of a program to enhance health promotion of older adults in primary care. Multi-agency partnerships were found to have high potential to promote health in this care context and patient population.

13 older adults, 6 general practitioners, and 9 agency managers (qual); 226 older persons (quan)

3 months

Unmet need

QUAN → QUAN(qual)*

Results

Dube, V., & Ducharme, F.(2014). Evaluation of a reflective practice intervention to enhance hospitalized elderly care: A mixed method study. Journal for Nurses in Professional Development, 30(1), 34–41.

To evaluate the effects of a reflective practice intervention on the attitudes, knowledge, and interventions of nurses who care for hospitalized older adults

127 nurses

22 weeks

Kogan’s Attitudes Toward Old People Scale; Palmore’s Facts on Aging Quiz

QUAN + QUAL*

Results

Duggleby, W. D., Degner, L., Williams, A., Wright, K., Cooper, D., Popkin, D., & Holtslander, L.(2007). Living with hope: Initial evaluation of a psychosocial hope intervention for older palliative home care patients. Journal of Pain and Symptom Management, 33(3), 247–257.

To evaluate the effectiveness of a psychosocial supportive intervention (“Living with Hope Program”) in increasing hope and quality of life for older adult, community-living, terminally ill cancer patients

60 terminally ill cancer patients

1 week

Baseline hope (Herth Hope Index [HHI]) and quality-of-life scores (McGill Quality of Life Questionnaire [MQOL]) were collected

quan + qual* “mixed method concurrent nested experimental design”

Results

Eaton, J., & Donaldson, G.(2016). Altering nursing student and older adult attitudes through a possible selves ethnodrama. Journal of Professional Nursing, 32(2), 141–151.

To develop, implement, and evaluate the feasibility of ethnodrama as an intervention to increase positive perceptions of aging in a sample of nursing students and older adults living in assisted living

12 nursing students, 12 long-term care residents

4 months

Quantitative data from student participants were analyzed using growth modeling, and older adult data were analyzed with a paired sample t-test.

QUAL + quan*

Results

Eaton, J. L.(2014). An arts-based intervention into perceptions of late life potential for nursing students and older adults (Unpublished doctoral dissertation). University of Utah, Salt Lake City.

To evaluate the effects of participation in the development and implementation of ethnodrama about possible selves on nursing students’ attitudes toward older adults and older adult attitudes to aging

12 nursing students; 12 older adult long-term care residents

12 weeks

Kogan’s Attitudes Toward Old People Scale; Polizzi’s Refined Version of the Aging Semantic Differential (rASD)

QUAN + QUAL*

Results

Eekelaar, C., Camic, P. M., & Springham, N.(2012). Art galleries, episodic memory and verbal fluency in dementia: An exploratory study. Psychology of Aesthetics, Creativity, and the Arts, 6(3), 262–272.

Trial testing whether aesthetic responses associated with viewing visual art have positive effects for people with dementia. Findings suggested that episodic memory could be enhanced through aesthetic responses to visual art, but found less evidence for verbal fluency.

6 dyads of caregivers and persons with dementia

4 weeks

Episodic memory and verbal fluency

quan(QUAL) → quan(QUAL) → quan(QUAL) → quan(QUAL) → quan(QUAL)*

Results

Ellard, D. R., Thorogood, M., Underwood, M., Seale, C., & Taylor, S. J.(2014). Whole home exercise intervention for depression in older care home residents (the OPERA study): A process evaluation. BMC Medicine, 12, 1.

Home exercise intervention for depression in older care home residents—process evaluation; low attendance—nursing home care culture and engagement issues including poor staff training and fewer “champions” for the intervention.

>1,000 in 78 care homes (staff in 8 homes)

12 months

Number of exercise groups attended; depressive symptoms

QUAN(qual) → QUAL (intervention observation) → QUAN(qual for staff) → QUAN (participants) + QUAL (intervention observation) → QUAN(qual for staff)*

Correct and provide additional training for intervention; Results

Evans, B. C., Belyea, M. J., Coon, D. W., & Ume, E.(2012). Activities of daily living in Mexican American caregivers: The key to continuing informal care. Journal of Family Nursing, 18(4), 439–466.

To determine feasible solutions for Mexican American caregivers to continue informal care for older adult family members

110 Mexican American family caregivers and care recipients

15 months

Katz Activities of Daily Living (ADL); demographics questionnaire; General Acculturation Index (GAI); Center for Epidemiological Studies Depression Scale (CESD)

QUAL + quan*

Results

Eyers, I., Young, E., Luff, R., & Arber, S.(2012). Striking the balance: Night care versus the facilitation of good sleep. British Journal of Nursing, 21(5), 303–307.

To identify determinants of poor sleep in care homes

145 older residents; 50 care staff

2 weeks

Standardized questionnaire related to how well the participants have slept; data from activity watches to determine how well the participants have slept

QUAL + quan*

Results

Falk, H., Wijk, H., & Persson, L.‑O.(2011). Frail older persons’ experiences of interinstitutional relocation. Geriatric Nursing, 32(4), 245–256.

Examined the effects of inter-institutional relocation on residents’ quality of life. Relocation was found to threaten person-centeredness across qualitative and quantitative data strands.

155 (quan only); 12 (qual only)

7 months

Quality of life, well-being, person-centeredness

QUAN → QUAN(qual)

Results

Farrington, C. J. T.(2014). Blended e-learning and end of life care in nursing homes: A small-scale mixed-methods case study. BMC Palliative Care, 13(1), 1–27.

Impact of e-learning/in-person workshop for end of life care in nursing homes; evaluate understanding/confidence in delivery of care and potential barriers. Improved confidence; shift toward holistic views.

20 nursing home staff

3 months post workshop

Changes in core competency areas

qual(quan) → QUAL (obs during workshop) → qual(quan)*

Results

Fleig, L., McAllister, M. M., Chen, P., Iverson, J., Milne, K., McKay, H. A., . . . Ashe, M. C.(2016). Health behaviour change theory meets falls prevention: Feasibility of a habit-based balance and strength exercise intervention for older adults. Psychology of Sport and Exercise, 22, 114–122.

Aimed to evaluate a fall intervention using a “habit formation” theory to support daily balance and strength exercises for older women.

13 older women

4 months

Short-Physical-Performance-Battery and psychological self-report measures (i.e., intention, self-efficacy, planning, action control, habit strength, quality of life)

QUAN + qual*

Results

Fuller, F. T., Johnson-Turbes, A., Hall, M. A., & Osuji, T. A.(2012). Promoting brain health for African Americans: Evaluating the healthy brain initiative, a community-level demonstration project. Journal of Health Care for the Poor and Underserved, 23(1), 99–113.

To evaluate the Alzheimer’s Association’s Health Brain Initiative. The intervention resulted in an increase in knowledge, awareness, and an intention to engage in health-protective behaviors.

220 community members; 44 community partners (N participating in qual only unclear)

Post-intervention (not clear the time)

Knowledge, awareness, behavioral intent

QUAN + QUAL

Results

Garcia, A., Marciniak, D., McCune, L., Smith, E., & Ramsey, R.(2012). Promoting fall self-efficacy and fall risk awareness in older adults. Physical & Occupational Therapy in Geriatrics, 30(2), 165–175.

To investigate whether participation in a modified version of the “Stepping On” program was effective in increasing fall self-efficacy, static and dynamic balance, and awareness of fall risks in older adults

19 older adults

7 weeks (met for 2 hours weekly for 7 weeks)

Modified Falls-Efficacy Scale, Get Up and Go Test, and Romberg Balance Test; quantized awareness of fall risks from focus group post-intervention

QUAN → QUAN → qual*

Results

Gavens, L., Goyder, E., Hock, E. S., Harris, J., & Meier, P. S.(2016). Alcohol consumption after health deterioration in older adults: A mixed-methods study. Public Health, 139, 79–87.

To examine if and how older adults modify their drinking after health deterioration, and the factors that motivate changing or maintaining stable drinking behavior

N varied (6,623–8,781) across three waves of data collection; 19 older adults diagnosed with long-term condition (qual)

5 years

Associations between diagnosis with a long-term condition or a worsening of self-rated health and changes in drinking frequency and alcohol volume consumed

QUAN + qual → QUAN + qual → QUAN + qual*

Results

Gell, L. (2013). Drinking in older adults: The role of changes in health and other influences on alcohol consumption over time (Doctoral dissertation). Available from ProQuest Dissertations & Theses: UK & Ireland; ProQuest Dissertations & Theses A&I. (1415102456)

Secondary data analysis of the English Longitudinal Study of Ageing (ELSA) examined the association between health and non-health changes and drinking frequency and volume change; qualitative interviews were used to explore the reasons for and processes of drinking change in 19 older adults who had been diagnosed with a long-term condition.

5,892 (quant); 19 (qual)

50 years

Alcohol consumption over time

QUAN → QUAN → QUAN → QUAN → QUAN → QUAN → QUAN → QUAN → QUAN → QUAN + qual*

Results

George, D. R.(2011). Intergenerational volunteering and quality of life: Mixed methods evaluation of a randomized control trial involving persons with mild to moderate dementia. Quality of Life Research, 20(7), 987–995.

RCT to assess whether an intergenerational volunteering intervention could enhance quality of life for persons with mild to moderate dementia

15 persons with dementia

5 months

Cognitive functioning, stress, depression, sense of purpose, and sense of usefulness; overall quality of life (QOL): perceived health benefits, sense of purpose and sense of usefulness, and relationships

quan → quan + qual*

Results

Gerdner, L. A.(2005). Use of individualized music by trained staff and family: Translating research into practice. Journal of Gerontological Nursing, 31(6), 22–30; quiz 55–56.

Effectiveness of individualized music for managing agitation among nursing home residents with dementia (translation). Agitation declined based on resident data as well as converging family and staff interviews.

8 resident family dyads; 10 certified nursing assistants

8 weeks

Agitation

QUAN + QUAL* (multiple time points)

Results

Gerdner, L. A., Hart, L. K., & Zimmerman, M. B.(2008). Craniosacral still point technique: Exploring its effects in individuals with dementia. Journal of Gerontological Nursing, 34(3), 36–45.

To explore the effects of craniosacral still point technique in those with dementia. There was a reduction in symptoms of agitation/aggression as measured by the Cohen-Mansfield Agitation Inventory.

9 older adults with dementia (qual and quan); 9 staff persons, 7 family members, and 5 therapists (qual only)

12 weeks

Agitation/aggression, degree of cognitive/functional impairment

QUAN + QUAL

Results

Glass, A. P.(2013). Lessons learned from a new elder cohousing community. Journal of Housing for the Elderly, 27(4), 348–368.

To evaluate a self-managed intentional co-housing community of older adults. Participants’ quality of life improved after the first 2 years, and they felt safe and comfortable as part of the community they had created.

43 older adults

4 years

Residence characteristics, response to elder cohousing, liking of specific features

quan → QUAL → quan → QUAL → quan → QUAL → quan → QUAL → quan* (5 waves of quan, and 4 waves of qual, over the course of 4 years)

Results and throughout the study

Glasson, J., Chang, E., Chenoweth, L., Hancock, K., Hall, T., Hill-Murray, F., & Collier, L.(2006). Evaluation of a model of nursing care for older patients using participatory action research in an acute medical ward. Journal of Clinical Nursing, 15(5), 588–598.

To develop a model of care to enhance nursing care quality for older adults who are hospitalized. The new model appeared to improve several outcomes for older persons.

60 older adults, 13 nurses

Not reported

Function, medication regime, caregiving activities

QUAN + QUAL*

Results

Grealish, L., Henderson, A., Quero, F., Phillips, R., & Surawski, M.(2015). The significance of “facilitator as a change agent”: Organisational learning culture in aged care home settings. Journal of Clinical Nursing, 24(7–8), 961–969.

To evaluate the viability of a student leadership model of clinical education. The intervention was successful in increasing student knowledge regarding sensory change, delirium, and drug reactions in older adults.

35 students and 15 staff; N’s in qual focus groups unclear

Last week of sessions (not clear the time)

Knowledge, and relating to older people

QUAN + QUAL

Results

Grealish, L., Lucas, N., Neill, J., McQuellin, C., Bacon, R., & Trede, F.(2013). Promoting student learning and increasing organizational capacity to host students in residential aged care: A mixed method research study. Nurse Education Today, 33(7), 714–719.

To examine the influence of an educational program on culture change in care homes

143 care staff in 3 care homes (quan only); 3 clinical educators (qual only)

6 months

Clinical Organisational Learning Cultures survey

(QUAN + qual) → (QUAN + qual)*

Results

Grigsby, T. J., Unger, J. B., Molina, G. B., & Baron, M.(2017). Evaluation of an audio-visual novela to improve beliefs, attitudes and knowledge toward dementia: A mixed-methods approach. Clinical Gerontologist, 40(2), 130–138.

An audio-visual dementia novela was presented aiming to improve dementia attitudes, beliefs, and knowledge of potential dementia caregivers and patients. It improved attitudes and knowledge about dementia, but no change in beliefs that screening would be beneficial.

42 caregivers and professionals

Post watching novela

Dementia knowledge, attitudes toward people with dementia, beliefs that screening would be beneficial

QUAN → QUAN + qual*

Results

Gustafsson, C., Svanberg, C., & Mullersdorf, M.(2015). Using a robotic cat in dementia care: A pilot study. Journal of Gerontological Nursing, 41(10), 46–56.

Pilot for ARDR persons and their caregivers’ reactions to interacting with a robotic cat to measure feasibility/utility of using it as a therapeutic tool. Interaction with the robotic cat resulted in less agitated behaviors and higher quality of life for those with dementia.

4 persons with dementia (quan); 14 caregivers and staff (qual)

2 weeks post-intervention (which occurred weeks 4–10)

Challenging behaviors occurrence; quality of life in dementia change scores

QUAN → quan + qual*

Results

Gustafsson, L., Liddle, J., Liang, P., Pachana, N., Hoyle, M., Mitchell, G., & McKenna, K.(2012). A driving cessation program to identify and improve transport and lifestyle issues of older retired and retiring drivers. International Psychogeriatrics, 24(5), 794–802.

To examine impact of a group program to promote adjustment to driving cessation. Performance improved as did lifestyle, understanding of transport option, and feelings of preparedness.

55 older adults

6 weeks

Canadian Occupational Performance Measure

(QUAN + QUAL) → (QUAN + QUAL)*

Results

Haas, R., Mason, W., & Haines, T. P.(2014). Difficulties experienced in setting and achieving goals by participants of a falls prevention programme: A mixed-methods evaluation. Physiotherapy Canada, 66(4), 413–422.

To evaluate the ability of participants of a falls prevention program to set and achieve goals

220 older adults; 9 practitioners

15 weeks

Number of appropriate goals set and achieved. Classified participants as being from a Culturally and Linguistically Diverse (CALD) background in the Australian context.

QUAN → QUAN + qual*

Results

Haltiwanger, E. P., & Brutus, H.(2012). A culturally sensitive diabetes peer support for older Mexican-Americans. Occupational Therapy International, 19(2), 67–75.

To evaluate a peer-led diabetes support group for older Mexican Americans, designed to improve adherence to medical recommendations. The program led to improvements in blood sugar as well as self-efficacy and personal resources.

42 older Mexican Americans

10 weeks

Self-efficacy, personal resources, change behaviors, attitudes toward diabetes, blood tests

QUAN → QUAL → QUAL → QUAL → QUAL → QUAN → QUAL → QUAL → QUAL → QUAN → QUAL → QUAL → QUAL → QUAN (10-week program; each week treated as a focus group, plus self-report surveys at 0, 2, 4, and 6 months)

Results

Hamel, A. V., Sims, T. L., Klassen, D., Havey, T., & Gaugler, J. E.(2016). Memory matters: A mixed-methods feasibility study of a mobile aid to stimulate reminiscence in individuals with memory loss. Journal of Gerontological Nursing, 42(7), 15–24.

To determine feasibility and acceptability of a tablet app for people with memory loss. Mixed findings suggested high utility and acceptability among residents, family, and staff.

18 persons with memory loss, 8 family members, and 6 residential care staff

1 month

System review checklist

quan + QUAL (multiple time points)

Results

Hammer, N. M., Bieler, T., Beyer, N., & Midtgaard, J.(2016). The impact of self-efficacy on physical activity maintenance in patients with hip osteoarthritis: A mixed methods study. Disability and Rehabilitation, 38(17), 1691–1704.

Explored the impact of self-efficacy (SE) on physical activity maintenance in patients with hip osteoarthritis after an exercise intervention. Compared maintainers to non-maintainers. Maintainers had higher SE; interviews suggest factors that increased SE (e.g., skills, encouragement, reframing).

52 (quan); 15 (qual)

12 months

Physical activity engagement, hip pain, and Arthritis Self-Efficacy Scale

QUAN → QUAN → qual*

Results

Hedley, L., Suckley, N., Robinson, L., & Dawson, P.(2010). Staying Steady: A community-based exercise initiative for falls prevention. Physiotherapy Theory and Practice, 26(7), 425–438.

To evaluate the community falls prevention program Staying Steady, aimed at reducing the likelihood of falling among older adults. Participants’ gait, balance, and strength improved through the intervention.

5 older adults

32 weeks

Gait balance, lower limb strength, grip strength

quan → QUAL → QUAL → QUAL → quan*

Results

Heliker, D., & Nguyen, H. T.(2010). Story sharing: Enhancing nurse aide–resident relationships in long-term care. Research in Gerontological Nursing, 3(4), 240–252.

Comparing Story Sharing (StS) and Communication Skills interventions on nurse aides’ levels of mutuality, empathy, job attitude, and self-efficacy and resident levels of empathy and perceived caring behaviors. Mutuality and empathy were significantly higher only in StS group post-intervention. (pilot)

84 nurse aides, 54 residents

Mutuality, empathy, self-efficacy, job-attitude, caring behaviors

NAs: QUAN → QUAN → qual → qual → QUAN + qual → qual → qual → QUAN + qual; residents QUAN + qual → QUAN → QUAN + qual → QUAN*

Results

Henwood, B. F., Katz, M. L., & Gilmer, T. P.(2015). Aging in place within permanent supportive housing. International Journal of Geriatric Psychiatry, 30(1), 80–87.

To evaluate a permanent supportive housing program, aimed at supporting aging in place among older adults with serious mental illness. The program was associated with declines in homelessness and justice system encounters.

3,990 ages 35–49 and 3,086 ages 50+ (quan); 5 staff (qual)

1 year

Mental health outcomes; days spent in various residential settings (e.g., unsheltered, justice system, independent apartment)

QUAN → QUAN → qual* (secondary analysis of state data; separate qual data collection via visits to PSH programs)

Results (thorough job of explicitly discussing the merged findings)

Hildon, Z., Smith, G., Netuveli, G., & Blane, D.(2008). Understanding adversity and resilience at older ages. Sociology of Health & Illness, 30(5), 726–740.

This study examined the relationship between adversity and resilience.

139 older adults

8 years (1997 → 2005)

CASP-19 scale; quality of life measures

QUAL + QUAN*

Results

Hile, E. S.(2011). Measuring perceived change in mobility and balance in older adults: A mixed-methods approach. Dissertation Abstracts International, Section B: The Sciences and Engineering, 72(1-B), 223.

To evaluate a self-rating screener for detecting mobility decline. Self-ratings did provide useful information over and above information available from other measures of mobility and balance.

104 (quan); 33 (qual)

1 year

State and transition self-ratings of balance and mobility; mental health outcomes; physical performance

QUAN → QUAN → QUAL*

Results

Hobbis, S.(2012). Adjusting to retirement: Changing views of normality (Doctoral dissertation). Available from ProQuest Dissertations & Theses: UK & Ireland; ProQuest Dissertations & Theses A&I. (1779550155)

To explore the effects of retirement on lifestyle (e.g., exercise, social engagement, finances) and to investigate the factors contributing to changes in behavior through the retirement transition. Retirement is an ongoing process, and successful retirement involved setting and following through on behavior change goals.

58 (quan); 20 (qual)

12 months

Health status, work commitments, retirement satisfaction, satisfaction with life, sources of enjoyment, self-efficacy, perceived stress, health behavior

QUAL → (QUAL + QUAN) → (QUAL + QUAN) → QUAL* A qualitative pilot study informed the quan items for the main study.

Quantitative items informed by pilot qualitative study; Results

Hooker, S. A., Ross, K., Masters, K. S., Park, C. L., Hale, A. E., Allen, L. A., & Bekelman, D. B.(2017). Denver Spirited Heart. Journal of Cardiovascular Nursing, 32(3), 226–235.

Pilot study to evaluate the feasibility, acceptability, and preliminary evidence regarding the efficacy of a resource-sparing psych spiritual intervention to improve QOL in heart failure patients.

33 heart failure patients

12 weeks: mixed methods, 1-group pretest-posttest pilot study design

Kansas City Cardiomyopathy Questionnaire, Patient Health Questionnaire, Meaning in Life Questionnaire, and Functional Assessment of Chronic Illness Therapy–Spiritual

QUAN → QUAN + qual*

Results

Huang, C. H., Crowther, M., Allen, R. S., DeCoster, J., Kim, G., Azuero, C., . . . Kvale, E.(2016). A pilot feasibility intervention to increase advance care planning among African Americans in the Deep South. Journal of Palliative Medicine, 19(2), 164–173.

To evaluate the feasibility of an advance care planning intervention among older African Americans in the Deep South. The intervention was successful in increasing advance care planning engagement.

30 older African American adults in the Deep South

Not reported

Study completion rate, average length of intervention, program satisfaction survey, knowledge

QUAN + QUAL

Results

Hutt, E., Radcliff, T. A., Oman, K. S., Fink, R., Ruscin, J. M., Linnebur, S., . . . McNulty, M.(2010). Impact of NHAP guideline implementation intervention on staff and resident vaccination rates. Journal of the American Medical Directors Association, 11(5), 365–370.

To examine whether a comprehensive approach to implementing national consensus guidelines for nursing home–acquired pneumonia, including influenza and pneumococcal vaccination, improves resident subject and staff vaccination rates

16 nursing homes from 1 corporation (N of nurses unknown)

3 influenza seasons, October to April 2004 to 2007

Resident vaccination rates

QUAN → QUAN + qual*

Results

Hutt, E., Ruscin, J. M., Linnebur, S. A., Fish, D. N., Oman, K. S., Fink, R. M., . . . McNulty, M. C.(2011). A multifaceted intervention to implement guidelines did not affect hospitalization rates for nursing home–acquired pneumonia. Journal of the American Medical Directors Association, 12(7), 499–507.

Determine if a comprehensive approach to implementing national consensus guidelines for nursing home–acquired pneumonia (NHAP) affected hospitalization rates. No significant differences between control and treatment group for hospitalization rates (low for all); nursing home nursing staff/leadership interviews described pressure/support to avoid hospitalization for treatment of acute infections.

1123 nursing home resident medical records from 16 facilities (quan); N of nurses unknown (qual)

2 years

nursing home medical records for resident characteristics, disease severity, and care processes

QUAN → QUAN → qual*

Results

Ingersoll-Dayton, B., Saengtienchai, C., Kespichayawattana, J., & Aungsuroch, Y.(2004). Measuring psychological well-being: Insights from Thai elders. The Gerontologist, 44(5), 596–604.

Developed a measure of psychological well-being based on the indigenous expertise of Thai elders.

477 (quan); 67 (qual, focus group); 30 (qual; cognitive interviews) Thai elders

Unspecified, 4 stages

Psychological well-being items

QUAL → ← QUAN → ← QUAL → ← QUAL*

Results

Izquierdo, A., Miranda, J., Bromley, E., Sherbourne, C., Ryan, G., Kennedy, D., & Wells, K.(2015). Grandparenting experiences among adults with a history of depression: A mixed-methods study. General Hospital Psychiatry, 37(2), 185–191.

The article describes the grandparenting experiences of a group of ethnically diverse older adults with a history of depression. Most report positive experiences, while those with a history of depression or recent episode were more likely to report a stressful experience.

750 (quan); 280 (qual) older adults with a history of depression

10 years

Positive and negative experiences; depression status

QUAN → QUAN → QUAN → QUAN → QUAN → QUAN → QUAN → QUAL → QUAL → QUAL*

Results

Johnston, B., Lawton, S., McCaw, C., Law, E., Murray, J., Gibb, J., . . . Rodriguez, C.(2016). Living well with dementia: Enhancing dignity and quality of life, using a novel intervention, Dignity Therapy. International Journal of Older People Nursing, 11(2), 107–120.

To assess the feasibility, acceptability, and potential effectiveness of Dignity Therapy to improve quality of life and reduce psychological and spiritual distress in older people with early stage dementia

27 participants (7 people with dementia; 7 family members; 7 stakeholder participants; 6 focus group members)

8 months

Herth Hope Index (HHI); Patient Dignity Inventory (PDI); perceived quality of life and satisfaction with life ratings

QUAL + quan*

Results

Jones, V. C., Gielen, A. C., Bailey, M. M., Rebok, G. W., Gaines, J. M., Joyce, J., & Parrish, J. M.(2013). “One of my fears is that physically or mentally, the time will come where I’ll be unable to drive anymore. And I’m not looking forward to that”: A mixed methods feasibility study to assess older driver’s risk impairment. Journal of Applied Gerontology, 32(4), 468–483.

To identify level of impairment among older drivers. The risk tool did not predict future crashes but was able to identify those who had a crash in the last 5 years.

67 (quan); 9 (qual) older adults

7 months

Motor perception, trail making B, useful field of view

QUAN + QUAL

Results

Kaasalainen, S., Wickson-Griffiths, A., Akhtar-Danesh, N., Brazil, K., Donald, F., Martin-Misener, R., . . . Dolovich, L.(2016). The effectiveness of a nurse practitioner-led pain management team in long-term care: A mixed methods study. International Journal of Nursing Studies, 62, 156–167.

To test an intervention for managing long-term care residents’ pain, involving a team of health professionals, led by a nurse practitioner. Pain teams significantly reduced residents’ pain and improved functional status.

345 long-term care residents from 6 long-term care homes

12 months

Resident pain, functional status, agitation, depression, clinical practice behaviors

QUAN → QUAN → QUAN → qual*

Results

Kamei, T., Itoi, W., Kajii, F., Kawakami, C., Hasegawa, M., & Sugimoto, T.(2011). Six month outcomes of an innovative weekly intergenerational day program with older adults and school-aged children in a Japanese urban community. Japan Journal of Nursing Science, 8(1), 95–107.

To describe intergenerational interactions among and between older people and children in a weekly intergenerational day program in an urban community, and to evaluate the older people’s health-related quality of life and depressive symptoms, compared to the program volunteers, as well as the children’s perspectives of older people, during the first 6 months of the program’s implementation

older people (n = 14, qual + quan), program volunteers (n = 8; qual), and school-aged children (n = 7; qual)

6 months

HRQOL (Medical Outcomes Study 8-Item Short-Form Health Survey) and depression (Geriatric Depression Scale, GDS-15)

QUAN + qual*

Results

Kelly, A. G.(2016). An experiential learning exercise exploring BSN nursing students’ cognitive and affective knowledge of age associated sensory changes. Dissertation Abstracts International, Section B: The Sciences and Engineering, 76(8-B(E)).

Assess the understanding of effects of aging through experiential learning activities (Sensory Kit, a Power Point© presentation and Unfair Hearing Test©) with freshman and sophomore nursing students. Participants were guided through reflection on their experiences. Sense of empathy and respect and concern for safety resulted in addition to increases in general knowledge about the aging processes.

72 nursing students

Post intervention (presentation)

Cognitive and affective knowledge

QUAN → quan + QUAL*

Results

Kent, F., Lai, F., Beovich, B., & Dodic, M.(2016). Interprofessional student teams augmenting service provision in residential aged care. Australasian Journal on Ageing, 35(3), 204–209.

To determine the usefulness of student-led interprofessional consultations within residential aged care in augmenting patient care and enhancing student education

26 health care students; 11 aged care residents

6 weeks

Patient Experience Questionnaire (PEQ); Dundee Ready Education Environment Measure

QUAN + qual*

Results

Kerr, S., Whyte, R., Watson, H., Tolson, D., & McFadyen, A. K.(2011). A mixed-methods evaluation of the effectiveness of tailored smoking cessation training for healthcare practitioners who work with older people. Worldviews on Evidence-Based Nursing, 8(3), 177–186.

To evaluate a 1-day smoking cessation training session for healthcare practitioners, to promote smoking cessation among older adults. Training was associated with improvement in healthcare practitioners’ knowledge and attitudes.

57 (quan); 8 (qual) older adult smokers

3 months

Knowledge, attitudes, and practice related to working with older people who smoke

QUAN → QUAN → QUAN → qual*

Results

King, B. J., Roberts, T. J., & Bowers, B. J.(2013). Nursing student attitudes toward and preferences for working with older adults. Gerontology & Geriatrics Education, 34(3), 272–291.

To explore the role of nursing education on attitudes and preferences of students toward older adults. Student attitudes and preferences improved over time, but students generally preferred to work in acute care settings and with children/young adults.

80 (quan); 10 (qual) students

End of second semester, senior year

Attitudes toward older adults, preferences for working with older adults

QUAN + QUAL

Results

Kirchen, T.(2013). Adaptation of veterans to long-term care: The impact of military culture (Unpublished doctoral dissertation). Denton: Texas Woman’s University.

To develop an intervention for the military to facilitate the transition to long-term care. Themes helped to inform the development of an intervention protocol; the intervention showed positive trends in improving physical function.

11 older adults

Unknown (6 sessions)

Activity engagement, social participation, quality of life

QUAL → quan → quan

Methods/design, with qualitative information intervention content

Klein, J., & Hopper, T.(2013). Restructuring a rehabilitation program for older adults: Effects on patient outcomes and staff perspectives. Canadian Journal on Aging, 32(2), 185–194.

To examine the impact of organizational change on patient outcomes and staff experiences in a rehabilitation program for older adults

255 (quan); 18 (qual)

4 months quant; 1 year qual

Demographics, length of stay, rehabilitation outcomes, rehabilitation efficiency, cognitive functioning, functional independence

QUAN → qual*

Results

Kluge, M. A., LeCompte, M., & Ramel, L.(2014). “Fit and fabulous”: Mixed-methods research on processes, perceptions, and outcomes of a yearlong gym program with assisted-living residents. Journal of Aging and Physical Activity, 22(2), 212–225.

To understand how to encourage assisted living residents to initiate and continue exercise in a gym setting

10 assisted living residents

1 year

Changes in active time, lower body strength, and workload were evaluated using direct measures

QUAN + qual*

Results

Knight, E., & Petrella, R. J.(2014). Prescribing physical activity for healthy aging: Longitudinal follow-up and mixed method analysis of a primary care intervention. The Physician and Sportsmedicine, 42(4), 30–38.

Describes the experience and health of older adults with an intervention involving a physical activity prescription and mHealth components. Gains were made in functional lung capacity.

20 older adults

6 months

Functional aerobic capacity (VO2max)

quan + qual*

Results

Kullgren, J. T., Harkins, K. A., Bellamy, S. L., Gonzales, A., Tao, Y., Zhu, J., . . . Karlawish, J.(2014). A mixed-methods randomized controlled trial of financial incentives and peer networks to promote walking among older adults. Health Education & Behavior, 41(1 Suppl.), 43S–50S.

To test whether an eHealth intervention including financial incentives and peer networks would encourage older adults to walk more. The technology did not increase older adults’ walking.

92 older adults

24 weeks

Proportion of days that walking goals were met; number of steps per day

QUAN → (ongoing QUAN + ongoing qual)* Baseline survey, plus ongoing quan data from Fitbit device, and ongoing qual data from online message boards

Results

Kuss, K., Leonhardt, C., Quint, S., Seeger, D., Pfingsten, M., Wolf, U., . . . Becker, A.(2016). Graded activity for older adults with chronic low back pain: Program development and mixed methods feasibility cohort study. Pain Medicine, 17(12), 2218–2229.

To evaluate the feasibility of a graded activity program for older adults with pain. The intervention was accepted, and participants had an increase in physical function.

Phase I (program development): Number of experts not reported; Phase II (feasibility pilot-study): 16 participants with pain (QUAL: participants and therapists)

2 post-intervention (9 weeks intervention)

Self-rated functional status, pain, falls, catastrophizing, avoidance beliefs

QUAN + QUAL

Results

LaManna, J. B., Bushy, A., Norris, A. E., & Chase, S. K.(2016). Early and intermediate hospital-to-home transition outcomes of older adults diagnosed with diabetes. Diabetes Educator, 42(1), 72–86.

To examine how factors such as general health status, perceived discharge readiness, and anticipated post-discharge support affect the hospital-to-home transition for older adults with diabetes who have been discharged from a hospital. Individuals with difficulty managing chronic non-diabetes health problems, and who reported difficulty coping post-discharge, were more likely to have a subsequent health problem requiring unplanned care following discharge.

96 older adults with diabetes

30 days

Unplanned care encounter occurrences, perceived transition quality, post-discharge difficulty

(QUAL + QUAN) → (QUAL + QUAN) → (QUAL + QUAN)*

Generated variables from qual data for use in statistical analysis

Langdon, R., Johnson, M., Carroll, V., & Antonio, G.(2013). Assessment of the elderly: It’s worth covering the risks. Journal of Nursing Management, 21(1), 94–105.

To evaluate the effectiveness of the Adult Patient Assessment Tool (APAT), particularly in relation to early identification of older people at risk of falls, pressure areas, cognitive impairment or delirium, or patients with mental illness or substance abuse

286 medical records (quan); 12 focus groups (quan)

2005 and 2009 medical records; focus groups conducted as medical record audit underway

Assessment of falls risk and mental illness increased

QUAN → QUAN → qual*

Results

Lazar, A., Demiris, G., & Thompson, H. J.(2016). Evaluation of a multifunctional technology system in a memory care unit: Opportunities for innovation in dementia care. Informatics for Health & Social Care, 41(4), 373–386.

To test a technological intervention to promote recreation and leisure activities such as social interaction, entertainment, exercise, and memory games among people with dementia. While staff and family members reported benefits of the system to people with dementia, technical and ethical concerns were barriers to optimal use of the system.

5 residents with dementia, 4 family members, 7 staff

6 months

Mental status, quality of life, depressive symptoms, resource utilization

Residents and family: (QUAL + quan) → (QUAL + quan) → (QUAL + quan); Staff: (QUAL + quan) → (QUAL + quan) → (QUAL + quan) → (QUAL + quan) → (QUAL + quan) → (QUAL + quan) → (QUAL + quan)* (separate data collection schedule for staff)

Results (only descriptive statistics, not really outcomes per se)

Lea, E., Marlow, A., Bramble, M., Andrews, S., Eccleston, C., McInerney, F., & Robinson, A.(2015). Improving student nurses’ aged care understandings through a supported placement. International Nursing Review, 62(1), 28–35.

To identify the potential for aged care placements and mentorships to deliver benefits for second-year nursing students. Knowledge, empathy, and attitudes around older adult and dementia care improved.

40 nursing students

3-week placement

Dementia attitudes and dementia knowledge

QUAL + quan → QUAL + quan*

Results

Lee, C. Y., Beanland, C., Goeman, D., Johnson, A., Thorn, J., Koch, S., & Elliott, R. A.(2015). Evaluation of a support worker role, within a nurse delegation and supervision model, for provision of medicines support for older people living at home: The Workforce Innovation for Safe and Effective (WISE) Medicines Care study. BMC Health Services Research, 15, 460.

To develop and assess an intervention to improve nutrition students’ attitudes toward older adults by working with an older adult from the community. The intervention group significantly improved their attitudes toward working with older adults.

100 nutrition students

Approx. 1 semester

Attitudes toward older adults, knowledge of aging, interest in working with older adults

(QUAL + quan) → (QUAL + quan)*

Results

Lee, F. K.(2012). Developing and piloting an exercise programme for older Chinese people with knee osteoarthritis in Hong Kong. Dissertation Abstracts International, Section B: The Sciences and Engineering, 73(6-B), 3531.

Evaluation of a support worker role within a nurse delegation and supervision model for provision of medicines support for older people living at home. Nurses reported positive experiences with the support.

27 nurses; 28 residents/care “consumers”

13 weeks

Workforce Innovation for Safe and Effective (WISE) Medicine Care model

quan + qual*

Results

Lee, S. Y., Hoerr, S. L., Weatherspoon, L., & Schiffman, R. F.(2008). Nutrition students improve attitudes after a guided experiential assignment with older adults. Journal of Nutrition Education and Behavior, 40(5), 279–287.

Pilot of the effects of a tailored exercise program for people with knee osteoarthritis on exercise adherence and health outcomes. Explored participants’ perception and experience of the program; intervention increased adherence and most positive health outcomes.

33 (quan); 6 (qual) older adults with knee osteoarthritis

12 weeks

Exercise adherence; health outcomes

QUAN → QUAN → QUAL*

Sample selection/Data analysis

Levasseur, M., Lefebvre, H., Levert, M. J., Lacasse-Bedard, J., Desrosiers, J., Therriault, P. Y., . . . Carbonneau, H.(2016). Personalized citizen assistance for social participation (APIC): A promising intervention for increasing mobility, accomplishment of social activities and frequency of leisure activities in older adults having disabilities. Archives of Gerontology and Geriatrics, 64, 96–102.

To assess the effects of a weekly social participation intervention on older adults with disabilities. Older adults who took part in the intervention experienced increased autonomy and fewer difficulties in their social environment.

16 older adults with disabilities

6 months

Functional autonomy, social participation, leisure, quality of life

QUAN → QUAN → qual*

Results

Lewis, A., Kitson, A., & Harvey, G.(2016). Improving oral health for older people in the home care setting: An exploratory implementation study. Australasian Journal on Ageing, 35(4), 273–280.

To explore an intervention for supporting older people to maintain good oral health. Older adults reported oral health improvements, while staff reported a better understanding of the importance of oral health for older adults.

319 older adults; N of staff unclear

Unclear. Study took place over 30 months, but not clear how much of that was preparation and analysis.

Oral health knowledge, attitudes, care provision, outcomes; evaluation of oral health training

(QUAN → QUAN) + qual* (Quan measures taken pre-and post-intervention; qual data collected throughout the study from team meetings)

Results

Liddle, J., Scharf, T., Bartlam, B., Bernard, M., & Sim, J.(2014). Exploring the age-friendliness of purpose-built retirement communities: Evidence from England. Ageing & Society, 34(9), 1601–1629.

Examines relative age-friendliness of purpose-built retirement communities. Argues for development to include the voices of its residents in planning.

122–156 residents; 12–16 management/staff

2 years

84 World Health Organization age-friendly city checklist items matched with other survey items

QUAL + quan → QUAL + quan*

Results

Lofqvist, C., Nygren, C., Brandt, A., & Iwarsson, S. (2009). Very old Swedish women’s experiences of mobility devices in everyday occupation: A longitudinal case study. Scandinavian Journal of Occupational Therapy, 16(3), 181–192.

To explore the everyday use of mobility devices by Swedish women over age 80, living alone. Participants reported on the challenges of maintaining independence while increasingly incorporating mobility devices into everyday activity.

3 Swedish women over age 80, living alone

5 years

Demographics, health status, functional limitations, ADLs, mobility device use, home modification

quan → (quan + QUAL) → QUAL*

Sample selection/Data analysis; Results

Lorenz, R. A.(2009). Indicators of preclinical disability: Women’s experiences of an aging body. Journal of Women & Aging, 21(2), 138–151.

This paper derived from a larger multimethod longitudinal study of women’s bodily experiences and coping practices before the onset of disability. The women felt that their bodies were out of synch with their environment.

12 older women

18 months

Repeated performance measures, physically challenging events, observations of daily activities

(quan+qual)*

Results

Loughnan, M. E., Carroll, M., & Tapper, N.(2014). Learning from our older people: Pilot study findings on responding to heat. Australasian Journal on Ageing, 33(4), 271–277.

A pilot study of older adults’ experiences related to extreme heat. Most older adults have modified their homes or have strategies to cope with extreme heat.

Phase I (focus group): 14 older adults; Phase II (household visit with semi-structured interviews): 20 households comprised of 26 individuals

36 days following household visit

Demographics, health, and housing modifications to keep cool

QUAL priority

Results

Luff, R., Ellmers, T., Eyers, I., Young, E., & Arber, S.(2011). Time spent in bed at night by care-home residents: Choice or compromise?Ageing & Society, 31(7), 1229–1250.

Examines the amount of time that care-home residents spend in bed at night and how factors like work shifts and independence affect it. Interviews highlighted lack of resident choice, especially among dependent residents, and compromise made around staff shift patterns. 12-hour shifts mean lots of extended bedtimes.

125 older adults from 10 nursing homes (quan); 38 (qual only)

14 diary days

Hours in bed and spent sleeping

quan → QUAL*

Results

MacNab, M., Lee, S. H., McCloughan, L., Hanley, J., McKinstry, B., & Pinnock, H.(2015). Oximetry-supported self-management for chronic obstructive pulmonary disease: Mixed method feasibility pilot project. BMC Health Services Research, 15, 485.

Examined the use of pulse oximetry “Light Touch” to support self-management for chronic obstructive pulmonary disease. Shows promise as a low-cost strategy to improve self-management and reduce reliance on clinical supervision.

51 older adults

6 months

St. George’s Respiratory Questionnaire (SGRQ); Hospital Anxiety and Depression Scale (HADS)

QUAL + quan*

Methods

Makai, P., Perry, M., Robben, S. H., Schers, H., Heinen, M., Olde Rikkert, M. G., & Melis, R. J.(2014). Which frail older patients use online health communities and why? A mixed methods process evaluation of use of the Health and Welfare portal. Journal of Medical Internet Research, 16(12), e278.

Evaluated differences in use of a personal online health community for frail older people and explored barriers/facilitators to using Health and Welfare Information Portal.

622 “frail patients”

2 years

Website use measures

qual + quan*

Results

McCrae, N., & Banerjee, S.(2011). Modernizing mental health services for older people: A case study. International Psychogeriatrics, 23(1), 10–19.

To evaluate progress and outcomes associated with a redevelopment program of mental health services for older adults. The workforce generally responded to changes in the new program, and services were reaching minority populations.

Phase I: 33 staff members (e.g., occupational therapists, physicians, support workers, and administrative); Phase II: 27 staff members

2 years

Work environment

Phase I: Qual priority Phase II: QUAN + QUAL

Results

McKechnie, V., Barker, C., & Stott, J.(2014). The effectiveness of an Internet support forum for carers of people with dementia: A pre–post cohort study. Journal of Medical Internet Research, 16(2), 415–428.

This mixed-methods study examined the impact of a well-respected U.K.-based online support forum for carers of people with dementia. Reported benefits of using the online system, showed in improvement in their relationship with their care recipient.

61 caregivers of persons with dementia

12 weeks

Generalized Anxiety Disorder scale (GAD-7); Patient Health Questionnaire (PHQ-9); Scale for the Quality of the Current Relationship in Caregiving

quan + qual*

Results

McLaughlin, D., Adams, J., Vagenas, D., & Dobson, A.(2011). Factors which enhance or inhibit social support: A mixed-methods analysis of social networks in older women. Ageing & Society, 31(1), 18–33.

Examined the factors that inhibit or enhance social support among older Australian women. Larger social networks were associated with better physical and mental health.

9,233 older adults

6 years

A survey of health and well-being

quan + qual*

Results

de Medeiros, K., Saunders, P. A., Doyle, P. J., Mosby, A., & Van Haitsma, K.(2012). Friendships among people with dementia in long-term care. Dementia: The International Journal of Social Research and Practice, 11(3), 363–381.

To investigate friendships among assisted living residents with moderate to advanced dementia

31 assisted living residents

6 months

Correlation between test scores or demographic characteristics; staff’s perceptions of residents’ friendships and self-report of friendships among residents

qual + quan*

Results

Molony, S. L., Evans, L. K., Jeon, S., Rabig, J., & Straka, L. A.(2011). Trajectories of at-homeness and health in usual care and small house nursing homes. The Gerontologist, 51(4), 504–515.

At-homeness and health over time between residents remaining in a usual care nursing home (ucNH) and residents moving from that home to a small house (SmH). Most participants who chose to stay in the ucNH reported high baseline levels of at-homeness and maintained this over the next 6 months; SmH group increased experience of home scores after the move (had lower home scores and more depressive symptoms before).

25 older adults

6 months

Depressive symptoms; Experience of Home Scale

qual + quan → qual + quan → qual + quan → qual + quan →

Results

Morgan-Brown, M.(2013). Changes in interactive occupation and social engagement for people with dementia: Comparing household to traditional nursing home environments in Ireland (Unpublished doctoral dissertation). University of Salford, Manchester, UK.

To understand and evaluate the effect of a change from a Traditional Model Unit (TMU) to a Household Model Unit (HMU) for people with dementia. The HMU environment resulted in interactive occupation and social engagement of residents, staff, and relatives in main sitting areas.

Pre-renovation interviews with staff (n = 25) and relatives (n = 22) were contrasted with 19 staff and 14 relatives post-renovation interviews

25 days

Time spent in communal living spaces, active social engagement, interactive occupations, time staff spent in the room

QUAN + qual → QUAN + qual*

Results

Moss, A. S., Reibel, D. K., Greeson, J. M., Thapar, A., Bubb, R., Salmon, J., & Newberg, A. B.(2015). An adapted mindfulness-based stress reduction program for elders in a continuing care retirement community: Quantitative and qualitative results from a pilot randomized controlled trial. Journal of Applied Gerontology, 34(4), 518–538.

To determine the feasibility of a mindfulness-based stress reduction (MBSR) program for older persons in a retirement community. Improvements were evident on several psychosocial well-being outcomes in both quantitative and qualitative data.

39 (quan only); 10 (qual + quan)

11 weeks

Mental and physical health, psychological flexibility, mindfulness, compassion, psychological distress

QUAN → QUAN [qual]

Results

Moyle, W., Jones, C., Cooke, M., O’Dwyer, S., Sung, B., & Drummond, S.(2014). Connecting the person with dementia and family: A feasibility study of a telepresence robot. BMC Geriatrics, 14, 7.

Assess the feasibility of using telepresence robot (“Giraffe”) to enhance engagement with person with dementia in nursing home and their family. Video analysis of interactions showed high level of engagement and a minimal level of negative emotions. Participants enjoyed the experience and families reported that the Giraffe robot offered the opportunity to reduce social isolation. Some technical difficulty was a barrier.

5 dyads (person with dementia + family caregiver)

6–8 weeks using Giraffe

Number of calls and duration; physical and verbal engagement

quan + QUAL → QUAL*

Results

Mullaney, S. E., Devereaux Melillo, K., Lee, A. J., & MacArthur, R.(2016). The association of nurse practitioners’ mortality risk assessments and advance care planning discussions on nursing home patients’ clinical outcomes. Journal of the American Association of Nurse Practitioners, 28(6), 304–310.

To investigate the impact nurse practitioners’ (NPs) documented mortality risk assessments (MRAs) and advance care planning (ACP) discussions have on clinical outcomes for newly enrolled Medicare Advantage nursing home patients

87 patients (quant), 14 focus group NPs (qual)

6 months

MRAs prioritize ACP discussions with patients/families; comfort goal of care, full-code status, hospitalization

QUAN → qual*

Results

Mullen, E. C.(2012). Effect of telephone counseling on physical activity among older adult cancer survivors (Unpublished doctoral dissertation). University of Texas at Tyler.

A dissertation examined the effect of a telephone counseling program on older adult cancer survivors. Telephone counseling did not result in an increase or improvement in physical activity level.

50 older adult cancer survivors

Post-intervention (~4 weeks, not clear the time)

Physical activity, health literacy, self-care

QUAN + QUAL

Results

Naylor, J. M., & Ko, V.(2012). Heart rate response and factors affecting exercise performance during home- or class-based rehabilitation for knee replacement recipients: Lessons for clinical practice. Journal of Evaluation in Clinical Practice, 18(2), 449–458.

This preliminary study aimed to determine whether patients in home- or class-based exercise programs can exercise in their heart rate training zone, aiming to identify factors influencing performance. Heart rate increases were achieved, but attenuated by health status (e.g., knee pain and stiffness) and general motivation.

42 older adults

6 weeks

Heart rate responses monitored

QUAN + qual*

Results

Nuttman-Shwartz, O.(2007). *Is there life without work?[http://dx.doi.org/10.2190/0628-w312-212p-h1j1]*International Journal of Aging and Human Development, 64(2), 129–147.

To examine how older adults perceive retirement and post-retirement work. A wide range of attitudes were identified related to the retirement transition.

56 older adults

2 years

Mental health, health

QUAL → QUAN*

Results

Nygren, C., & Iwarsson, S.(2009). Negotiating and effectuating relocation to sheltered housing in old age: A Swedish study over 11 years. European Journal of Ageing, 6(3), 177–189.

To explore how older persons make relocation decisions. A process of location was constructed using both quantitative and qualitative data.

13 older adults

11 years

Function, adaptation to housing, subjective well-being

quan → quan → quan → QUAL

Sample selection/Data analysis

Nystrom, M. E., Strehlenert, H., Hansson, J., & Hasson, H.(2014). Strategies to facilitate implementation and sustainability of large system transformations: A case study of a national program for improving quality of care for elderly people. BMC Health Services Research, 14, 401.

To explore the characteristics of strategies to facilitate implementation of a national program for severely ill older adults. The primary strategy used to implement the program included implementation coaches, strategic management teams, quality registries, financial incentives, and agreements.

23 non-participant observations (quan) and 795 documents for review (quan); 11 key stakeholders (qual)

6 years of program implementation data

Preventive care, palliative care, dementia care, pharmacological treatment

QUAL priority

Results

Oeseburg, B., Hilberts, R., Luten, T. A., van Etten, A. V., Slaets, J. P., & Roodbol, P. F.(2013). Interprofessional education in primary care for the elderly: A pilot study. BMC Medical Education, 13, 161.

A pilot study to develop an interprofessional education program for general practitioners and practice nurses to improve care for older adults. Following the intervention, provider attitudes toward elderly care changed and interprofessional education added value to defining the role of general practitioners and nurses in care of older adults.

10 general practitioners and 10 practice nurses (quan); 6 general practitioners and 6 practice nurses (qual)

Not reported

Division of tasks/responsibilities (case finding, medical assessment, medication, care planning, communication with patient, execution of care plan, consultation with specialists and community services, monitoring care plan)

QUAN + QUAL

Results

Ottmann, G., & Mohebbi, M.(2014). Self-directed community services for older Australians: A stepped capacity-building approach. Health & Social Care in the Community, 22(6), 598–611.

Reports on a consumer-directed care (CDC) approach for older Australians with complex care needs. Concludes that a stepped capacity-building approach to CDC may improve the acceptability of CDC to older people and generate synergies that improve older people’s care outcomes

109 (quan); 56 (qual) older adults with complex care needs

11 months

Satisfaction with the way they were treated, care options, the “say” they had in their care, the information they received regarding their care

QUAN → QUAN + qual*

Results

Paone, D.(2014). Using RE-AIM to evaluate implementation of an evidence-based program: A case example from Minnesota. Journal of Gerontological Social Work, 57(6–7), 602–625.

To examine the implementation experience and describe sustainability issues of an evidence-based intervention for spousal caregivers. The program was well-received but ultimately not sustainable.

14 organizations

4 years

Cost data; caregiver experience data

QUAN + qual*

Results

Pesut, B., McLean, T., Reimer-Kirkham, S., Hartrick-Doane, G., Hutchings, D., & Russell, L. B.(2015). Educating registered nursing and healthcare assistant students in community-based supportive care of older adults: A mixed methods study. Nurse Education Today, 35(9), e90–96.

To explore whether a collaborative educational intervention could develop registered nursing and healthcare assistant students’ capabilities in supportive care while enhancing care of clients with advanced chronic illness in the community

63 nurses and health students

3 time points (unspecified)

Pre- and post-test measures of self-perceived competence and knowledge in supportive care were collected at 3 time points

QUAN + qual → QUAN + qual → QUAN + qual*

Results

Phelan, C.(2010). An innovative approach to targeting pain in older people in the acute care setting. Contemporary Nurse: A Journal for the Australian Nursing Profession, 35(2), 221–233.

To determine (a) the feasibility of the study design for a larger multi-site project and (b) whether a pain education promotion approach, termed “Targeting Pain,” using a multidisciplinary educational campaign and promotional media such as staff badges and ward signage, improves the detection and management of pain in older people in an acute care setting.

14 medical staff, 45 nursing staff, 3 health staff; 10 patients

12 weeks

Pre- and post-evaluation surveys

quan + qual*

Results

Phinney, A., Moody, E. M., & Small, J. A.(2014). The effect of a community-engaged arts program on older adults’ well-being. Canadian Journal on Aging, 33(3), 336–345.

To evaluate the effect of a community-engaged arts program on the physical, emotional, and social well-being of seniors. They described improved perceptions of overall health, experience of pain, and sense of community.

51 older adults

3 years

Perceived overall health, experience of pain, sense of community

quan → qual*

Results

Porter, M. M., & Tuokko, H. A.(2011). An evaluation of the Roadwise Review: A mixed methods approach. Traffic Injury Prevention, 12(5), 451–458.

Evaluation of the Roadwise Review CD-ROM (RWR), a self-screening tool for older drivers. Almost all participants (96%) were found to have at least one impairment. Participants reported that the RWR was useful, they made changes to their driving, and they talked to their family and friends about driving.

96 older adults

2 weeks

Impairment (visual acuity and visual search), health statuses/medication use, levels of PA

QUAN → QUAN + qual → QUAN + qual*

Results

Puts, M. T. E., Sattar, S., McWatters, K., Lee, K., Kulik, M., MacDonald, M. E., . . . Alibhai, S. M. H.(2017). Chemotherapy treatment decision-making experiences of older adults with cancer, their family members, oncologists and family physicians: A mixed methods study. Supportive Care in Cancer, 25(3), 879–886.

To better understand the treatment decision process from older adults, their families, and healthcare providers related to cancer. Older adults wanted a say in their care processes, but also trusted and valued their oncologists/physicians’ opinions.

20 older adults with cancer; 24 family members; 13 oncologists; 15 family physicians

6 months

Completed surveys after both semi-structured interviews to obtain social demographic information, and information on health

QUAL → quan*

Results

Quasdorf, T., Riesner, C., Dichter, M. N., Dortmann, O., Bartholomeyczik, S., & Halek, M.(2017). Implementing Dementia Care Mapping to develop person-centred care: Results of a process evaluation within the Leben-QD II trial. Journal of Clinical Nursing, 26(5/6), 751–765.

To evaluate the feasibility of implementing a complex, person-centered care intervention, Dementia Care Mapping (DCM), in nursing homes. Translating DCM to nursing home settings was difficult, requiring a well-functioning, flexible, dementia-friendly culture, and well-qualified, experienced project leaders.

9 nursing units in nursing homes

2 years

Dementia friendliness of the environment, organizational characteristics (e.g., living structure, finances, staff structure), treatment fidelity

(QUAN + QUAL) → (QUAN + QUAL) → (QUAN + QUAL), also ongoing QUAL* (quan measures and interviews at T0, T1, and T2; documents collected throughout)

Results (good discussion of merging)

Quine, S., Wells, Y., de Vaus, D., & Kendig, H.(2007). When choice in retirement decisions is missing: Qualitative and quantitative findings of impact on well-being. Australasian Journal on Ageing, 26(4), 173–179.

To explore the importance of retiring individuals’ sense of choice about retirement for their likelihood of returning to work, and their well-being following retirement. Sense of choice was pivotal to participants’ retirement adjustment and predicted health and well-being outcomes.

601 (quan); 67 (qual)

3 years

Self-rated health, positive affect, negative affect, self-image, life satisfaction, marital cohesion

QUAL → QUAN → QUAN → QUAN → QUAN*

Sample selection/Data analysis: Focus groups informed the quan survey; Results

Ralphs-Thibodeau, S., Knoefel, F., Benjamin, K., Leclerc, A., Pisterman, S., Sohmer, J., & Scrim, C.(2006). Patient choice: An influencing factor on policy-related research to decrease bedrail use as physical restraint. Worldviews on Evidence-Based Nursing, 3(1), 31–39.

To evaluate the use of bedrails compared to no bed rails. The randomization process failed due to patient self-selection reflecting strong patient preferences.

60 older adults admitted to a rehabilitation unit

Discharge from rehabilitation unit

Functional ability, depression, medical complexity

QUAN + QUAL

Results

Ramirez, E. M.(2016). Development and implementation of the Generations Eating Together Through Cooking (G.E.T.T. Cooking) curriculum and its effects on an inter-generational population: A pilot study. Dissertation Abstracts International, Section B: The Sciences and Engineering, 77(5-B(E)).

A dissertation reporting on the development and implementation of a cooking curriculum for grandchildren/grandparents. The cooking curriculum resulted in an increase in cooking self-efficacy and nutritional knowledge.

6 grandchild/grandparent dyads

2 months

Cooking self-efficacy, nutritional knowledge, family meal frequency

QUAN + QUAL

Results

Restorick Roberts, A., Betts Adams, K., & Beckette Warner, C.(2017). Effects of chronic illness on daily life and barriers to self-care for older women: A mixed-methods exploration. Journal of Women & Aging, 29(2), 126–136.

To explore the experience of those living with chronic conditions. Most participants did not practice 100% of self-care behaviors.

138 older adults with chronic conditions

6 months

Self-management behaviors, health and functioning, social support, self-efficacy, depression

QUAN + QUAL

Results

Richardson, J. C., Moore, A. J., Bernard, M., Jordan, K. P., & Sim, J.(2015). Living well with chronic pain in later life: The role and meaning of activity and involvement. Activities, Adaptation & Aging, 39(3), 200–213.

To develop a cognitive behavioral therapy intervention for older adults who are depressed. Mixed methods were used to create the intervention process.

14 experts, 5 older adults

15 weeks

Health, depression, anxiety, mood

QUAL → QUAL(quan) → QUAL(quan) → QUAN(qual)*

Sample selection/Data analysis

Richardson, L., & Reid, C.(2006). “I’ve lost my husband, my house and I need a new knee . . . why should I smile?” Action research evaluation of a group cognitive behavioural therapy program for older adults with depression.Clinical Psychologist, 10(2), 60–66.

Evaluating how older people can be helped to live well with musculoskeletal pain. Physical activity and living engaged lifestyles brought meaning into the lives of older people living with pain and were associated with reporting minimal interference because of pain.

1,880 (quan); 60 (qual) older adults with musculoskeletal pain

6 years

Level of pain; interference of life activities due to pain

QUAN → QUAN → QUAN → qual*

Sample selection/Data analysis: Used pain status at baseline, 3- and 6-year follow-up to identify 3 groups to interview (no pain, pain w/interference, pain w/o interference); Results

Riebe, G., Fan, M. Y., Unutzer, J., & Vannoy, S.(2012). Activity scheduling as a core component of effective care management for late-life depression. International Journal of Geriatric Psychiatry, 27(12), 1298–1304.

Examined participant records from the Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) trial to identify activity scheduling strategies used in the context of successful depression care management (CM), associations of activity scheduling with self-reported activity engagement, and depression outcomes.

4,335 CM session notes from 597 participants

12 months

Activity scheduling, activity engagement, depression outcomes

(quan + qual)*

Results

Roberts, G., Morley, C., Walters, W., Malta, S., & Doyle, C.(2015). Caring for people with dementia in residential aged care: Successes with a composite person-centered care model featuring Montessori-based activities. Geriatric Nursing, 36(2), 106–110.

To describe the development and evaluation of a person-centered model of dementia care. The person-centered model of care resulted in a reduction in antipsychotic and sedative medication use.

15 persons with dementia

7 months

Use of antipsychotics or sedatives, behavioral and psychological symptoms, staff outcomes

quan + QUAL

Results

Roberts, H. C., De Wet, S., Porter, K., Rood, G., Diaper, N., Robison, J., . . . Robinson, S.(2014). The feasibility and acceptability of training volunteer mealtime assistants to help older acute hospital inpatients: The Southampton Mealtime Assistance Study. Journal of Clinical Nursing, 23(21–22), 3240–3249.

To evaluate a program for training volunteers to serve as mealtime assistants for older patients in a hospital setting. The training was well received, and many volunteers engaged in sustained volunteering beyond the study.

12 volunteers, 9 patients, 17 nurses

1 year

Feasibility measures: number of volunteers, delivery and content of training program, mealtime activity

QUAL + quan* (not clear from the manuscript when each assessment took place; descriptive data about feasibility appears to have been measured throughout the year-long study and focus groups/interviews conducted throughout as well)

Results

Robinson, L., Newton, J. L., Jones, D., & Dawson, P.(2014). Promoting self-management and adherence with strength and balance training for older people with long-term conditions: A mixed-methods study. Journal of Evaluation in Clinical Practice, 20(4), 318–326.

To explore the process of behavior change in a small sample of older people with the fall-associated chronic liver disease, primary biliary cirrhosis (PBC), receiving either a standard or an enhanced program of strength and balance training. Longer periods of clinical support are necessary to reduce risk of falling.

9 older adults with chronic liver disease

6 months

PBC-40 (a health-related quality of life questionnaire specific to PBC); Falls Efficacy Scale–International; the Self-Efficacy for Exercise Scale

QUAL + quan*

Results

Ross, A. J., Anderson, J. E., Kodate, N., Thomas, L., Thompson, K., Thomas, B., . . . Jaye, P.(2013). Simulation training for improving the quality of care for older people: An independent evaluation of an innovative programme for inter-professional education. BMJ Quality & Safety, 22(6), 495–505.

To evaluate a simulation training program for staff of older persons in an inpatient care unit. Staff outcomes improved after the simulation, and learning and teamwork also increased.

57–77 (quan); 27 (qual)

2 days

Self-rating of competencies

QUAN + qual*

Results

Ross, M. M., Rosenthal, C. J., & Dawson, P.(1997). Spousal caregiving in the institutional setting: Visiting. Journal of Clinical Nursing, 6(6), 473–483.

To investigate the frequency, quality, and meaning of visiting for wives whose husbands are in long-term residential care (i.e., “quasi-widows”). Spouses visited for various reasons including love, duty, and monitoring their husbands’ health. Spouse feelings of satisfaction were associated with their husbands’ well-being and feeling useful to husband and staff.

46 “quasi-widows”

9 months

Objective and subjective aspects of visiting, health problems, level of assistance, Zarit Burden Inventory, physical health, morale, depressive symptomatology, quality of marital relationship, institutional factors

(QUAL + QUAN) → (QUAL + QUAN) → (QUAL + QUAN) → (QUAL + QUAN) → (QUAL + QUAN) → (QUAL + QUAN)*

Results (fully merged)

Salter, C., McDaid, L., Bhattacharya, D., Holland, R., Marshall, T., & Howe, A.(2014). Abandoned acid? Understanding adherence to bisphosphonate medications for the prevention of osteoporosis among older women: A qualitative longitudinal study. PLOS ONE, 9(1), e83552.

To describe perceptions of adherence to medication among older women at risk for fracture. Predictors of adherence did not differ over time, but various themes were identified that influence adherence.

30 older women at risk for fracture

24 months

Medication adherence

QUAN(qual → qual)

Sample selection/Data analysis: Risk of fracture was used to identify qualitative sample.

Samia, L. W., Aboueissa, A. M., Halloran, J., & Hepburn, K.(2014). The Maine Savvy Caregiver Project: Translating an evidence-based dementia family caregiver program within the RE-AIM Framework. Journal of Gerontological Social Work, 57(6–7), 640–661.

Findings of a 3-year Savvy Caregiver Program translational study designed with the RE-AIM framework to create a statewide sustainable infrastructure and improve dementia family caregiver outcomes in one rural state. Caregivers reported improved confidence and fewer depressive symptoms. Adequate trainer resources, partnerships, and planning made the program viable and sustainable.

676 (quant), 10 (qual focus group) family caregivers of persons with dementia

3 years

Program reach, effectiveness, adoption, implementation, and maintenance

QUAN → qual*

Results

Schell, R., Hausknecht, S., Zhang, F., & Kaufman, D.(2016). Social benefits of playing Wii bowling for older adults. Games and Culture: A Journal of Interactive Media, 11(1–2), 81–103.

Study investigated whether playing a digital game, Wii Bowling, with others can enhance the social life of older adults. Reports of social connectedness increased and loneliness decreased post-intervention.

73 (quant), 17 (qual post-tournament interview)

8 weeks

Level of social connectedness, level of loneliness

quan → quan + qual*

Results

Schonberg, M. A., Birdwell, R. L., Bychkovsky, B. L., Hintz, L., Fein-Zachary, V., Wertheimer, M. D., & Silliman, R. A.(2014). Older women’s experience with breast cancer treatment decisions. Breast Cancer Research and Treatment, 145(1), 211–223.

To understand women’s experience with breast cancer treatment decision making. Recommendations from the surgeon were the most influential in affecting a woman’s choice of treatment.

70 older women who received a breast biopsy

6 months

Decision making, disease knowledge

QUAN + QUAL

Results

Schonberg, M. A., Silliman, R. A., Ngo, L. H., Birdwell, R. L., Fein-Zachary, V., Donato, J., & Marcantonio, E. R.(2014). Older women’s experience with a benign breast biopsy: A mixed methods study. Journal of General Internal Medicine, 29(12), 1631–1640.

To examine the psychological impact and experience of women >65 years of age with a benign breast biopsy. Participants described anxiety and discomfort during the biopsy and wished they had had more information to prepare themselves for the experience.

94 older women with a benign breast biopsy

6 months

Validated negative psychological consequences of screening mammography questionnaire (PCQ)

QUAN + qual*

Results

Schwingel, A., Gálvez, P., Linares, D., & Sebastião, E.(2017). Using a mixed-methods RE-AIM framework to evaluate community health programs for older Latinas. Journal of Aging and Health, 29(4), 551–593.

RE-AIM framework to evaluate promotora community health program for older Latinas in Chicago. It improved eating habits and physical activity levels and reduced depressive symptoms. Challenges discussed, but promotoras felt well trained.

34 older Latina participants (quan); 14 participants, 2 community organization leaders, 3 promotoras (qual)

9 months

Food habits, accelerometers (PA), depressive symptoms

QUAN → QUAN + qual → QUAN*

Results

Selman, L. E., Williams, J., & Simms, V.(2012). A mixed-methods evaluation of complementary therapy services in palliative care: Yoga and dance therapy. European Journal of Cancer Care, 21(1), 87–97.

Evaluating yoga and dance therapy to compliment palliative care services (alone or combined). Patients were concerned with mobility/fitness, breathing problems, aches and posture issues, difficulty relaxing, and fear/anxiety. Concern for these issues was statistically significantly reduced for both therapies, while well-being improvement was clinically significant for yoga.

18 older adults receiving palliative care

6 weeks

Concern nomination, well-being scores

QUAN + qual → QUAN + qual*

Mixed methods instrument (“Measure Yourself Concerns and Wellbeing Questionnaire”); Results

Seymour, J. E., Almack, K., Kennedy, S., & Froggatt, K.(2013). Peer education for advance care planning: Volunteers’ perspectives on training and community engagement activities. Health Expectations, 16(1), 43–55.

To evaluate a 3-day educational intervention designed to train volunteers to undertake peer education on advance care planning. Most volunteers continued taking part in peer education activities 1 year after training.

24 older volunteers, 8 staff members

12 months

Training evaluation questions, views about training

(quan + qual) → quan → QUAL → QUAL* (evaluative activities during training; quan survey at 4 months; focus groups at 6 months; interviews at 12–18 months)

Sample selection/Data analysis: Qual/quan questionnaire informed focus groups and interviews.

Siddiqi, N., Young, J., House, A. O., Featherstone, I., Hopton, A., Martin, C., . . . Holt, R.(2011). Stop Delirium! A complex intervention to prevent delirium in care homes: A mixed-methods feasibility study. Age and Ageing, 40(1), 90–98.

To test the feasibility of “Stop Delirium!,” an intervention to prevent delirium in care homes for older people, and to optimize parameters to inform the design of a future trial evaluation. Staff had positive attitudes regarding the intervention; preliminary results show trends toward reductions in problem behaviors and falls.

286 residents from 6 care homes

10 months

Staff reports of delirium

QUAL + quan*

Methods

Skilbeck, J. K., Payne, S. A., Ingleton, M. C., Nolan, M., Carey, I., & Hanson, A.(2005). An exploration of family carers’ experience of respite services in one specialist palliative care unit. Palliative Medicine, 19(8), 610–618.

To investigate the experiences of family caregivers whose relatives had been admitted to a 2-week inpatient respite care program in a hospice setting. Caregivers felt that respite care enabled them to have a valuable break, though it may be more appropriate for caregivers whose relative has a chronic, life-long illness, rather than those who are near the end of life.

25 caregivers of persons admitted to hospice

Unclear; data collected pre- and post-respite (approx. 2 weeks)

Relative stress

(QUAL + quan) → (QUAL + quan)*

Results

Skropeta, C. M., Colvin, A., & Sladen, S.(2014). An evaluative study of the benefits of participating in intergenerational playgroups in aged care for older people. BMC Geriatrics, 14, 109.

Explore benefits of intergenerational playgroups for adults with dementia, (grand)parents/caregivers, and children 0–4 in nursing homes. Trend to reducing fatigue, no differences in depressive symptoms for older adults. Friendships, connectedness, and personal growth were a couple of the qual themes.

48 older adult residents, 41 child carers, 50 children 0–4 years

6 months

SF36 and geriatric depression scale

QUAN → qual → QUAN* OR QUAN → QUAN + qual* depending on site

Results

Smythe, A., Jenkins, C., Harries, M., Atkins, S., Miller, J., Wright, J., . . . Oyebode, J.(2014). Evaluation of dementia training for staff in acute hospital settings. Nursing Older People, 26(2), 18–24.

Evaluate brief psychosocial training for staff working with people with dementia in acute hospital settings. Contradictory quan and qual outcomes preclude firm conclusions of intervention’s efficacy. High dropout rate, lack of attendance to training sessions. (pilot)

66 (quan); 15 (qual) staff working with persons with dementia

Post training session

Inventory of Geriatric Nurse Self-Efficacy, Approaches to Dementia Questionnaire, Maslach Burnout Inventory, Alzheimer’s Disease Knowledge Scale

QUAN → QUAN → QUAN → qual*

Results

Soderlund, M., Norberg, A., & Hansebo, G.(2014). Validation method training: Nurses’ experiences and ratings of work climate. International Journal of Older People Nursing, 9(1), 79–89.

Nurses’ experience with training program on attitudes and work experiences with persons with dementia in nursing homes. Improved work climate after the training program, though interviewees said it imposed more work stress (not reflected in questionnaire).

53–56 entire staff (quan); 12 nurses (qual)

1 year

Creative climate questionnaire

QUAN → QUAN + qual*

Results

Stijnen, M. M., Jansen, M. W., Duimel-Peeters, I. G., & Vrijhoef, H. J.(2014). Nurse-led home visitation programme to improve health-related quality of life and reduce disability among potentially frail community-dwelling older people in general practice: A theory-based process evaluation. BMC Family Practice, 15, 173.

To evaluate a program for potentially frail older people, involving in-home geriatric assessment and targeted follow-up care. While the home visitation program was judged positively by health practitioners and older adults, the delivery did not fully reach the target audience.

24 general practices

18 months

Number of home visits, compliance with recommendation, evaluation of intervention, benefits of intervention, reach

QUAN + QUAL (Complex and difficult to chart on a timeline. Interviews with nurses at 3 months, 6 months, and end; interviews with GPs at end; interviews with older people at 3–5 weeks; ongoing quan data collected throughout intervention; quan survey to nurses at 18 months; quan training evaluation to nurses; diary for older adults; ongoing participation notes by research team.)

Results

Stromberg, A., & Jaarsma, T.(2008). Thoughts about death and perceived health status in elderly patients with heart failure. European Journal of Heart Failure, 10(6), 608–613.

To explore views about death and health in older adults with heart failure following a hospitalization. Fear of death did not change from admission to discharge.

145 older adults with heart failure

6 months

Perceived health

QUAN → qual

Results

Tak, S. H., Zhang, H., Patel, H., & Hong, S. H.(2015). Computer activities for persons with dementia. The Gerontologist, 56(Suppl. 1), S40–49.

Persons with dementia’s experience with various engaging computer activities (music, videos, games, email, etc.) over 7 weeks. Feeling tired (associated with older participants) was associated with fewer computer activity sessions. All participants needed IT help.

27 persons with dementia

7 weeks

Activity-monitoring log of computer use, participant engagement, physiological and psychosocial needs before every computer session

QUAL → QUAN + qual → QUAL*

Results

Taylor, J., Barker, A., Hill, H., & Haines, T. P.(2015). Improving person-centered mobility care in nursing homes: A feasibility study. Geriatric Nursing, 36(2), 98–105.

A pilot study evaluating a person-centered care training program. The intervention is feasible, practical, and accepted.

12 residents and 51 staff; 10 staff (qual focus groups)

16 weeks

Staff outcomes (knowledge, satisfaction, care transfers), resident outcomes (mobility, autonomy)

QUAN + QUAL

Results

Theis, S. L., Moss, J. H., & Pearson, M. A.(1994). Respite for caregivers: An evaluation study. Journal of Community Health Nursing, 11(1), 31–44.

To evaluate the effect of respite care on family caregivers of older adults. Though caregivers expressed satisfaction with respite, no statistically significant changes were found. However, there were unanticipated attrition issues that interfered with the intended study design.

130 (only 18 remained in the program at 12 months; quan); 6 (qual)

12 months

Mood, quality of life, impact of caregiving

QUAN → QUAN → QUAN → qual*

Results

Theurer, K., Wister, A., Sixsmith, A., Chaudhury, H., & Lovegreen, L.(2014). The development and evaluation of mutual support groups in long-term care homes. Journal of Applied Gerontology, 33(4), 387–415.

To describe the development of a mutual support group intervention for residents of long-term care settings. Both residents and staff reported positive benefits across the quantitative and qualitative data strands.

65 residents, 7 staff in long-term care setting

12 weeks

Loneliness, development of friendships, and coping skills, understanding, support

QUAL + quan (multiple time points)

Results

Thomas, B., Connelly, D., & Laliberte-Rudman, D.(2008). The impact and use of walkers among older adults: A pilot. Physical & Occupational Therapy in Geriatrics, 27(1), 36–72.

To examine the effect of the use of a walker on functional performance. To optimize walker adoption, providers must take account of personal, performance, and environmental factors.

4 older adults using a walker

QUAN: 1 month; QUAL: within 1 year of last quan follow-up

Timed mobility, balance confidence

QUAN → qual

Results

Tomsone, S., Haak, M., & Lofqvist, C.(2016). Experiences of mobility device use over time: A multiple case study among very old Latvian women. Scandinavian Journal of Occupational Therapy, 23(1), 67–78.

To explore the use of mobility devices in older women. Case studies indicate that older women accept and use mobility devices.

59 (although not entirely clear)

QUAN: 9 years; QUAL: 8 years following first QUAN interview

Perceived health, functional independence, functional limitations

QUAN → qual

Results

van Beljouw, I. M., Laurant, M. G., Heerings, M., Stek, M. L., van Marwijk, H. W., & van Exel, E.(2014). Implementing an outreaching, preference-led stepped care intervention programme to reduce late life depressive symptoms: Results of a mixed-methods study. Implementation Science, 9, 107.

Implement an outreaching, preference-led stepped care intervention program to reduce late-life depressive symptoms. Participants felt the screening imposed significant burdens, and thus uptake of the routine screening was poor and drop-out rates were high. They preferred interventions that focused on interpersonal contact and were effective if delivered by healthcare nurses with mental health experience.

263 older adults

9 months

PHQ-9 (Patient Health Questionnaire-9)

QUAN + QUAL*

Methods

Waldrop, D. P.(2007). Caregiver grief in terminal illness and bereavement: A mixed-methods study. Health & Social Work, 32(3), 197–206.

To explore and describe the lived experience of caregiver grief following a care recipient’s death. Following death, caregivers experienced diminished distress and anxiety, but also experienced loneliness and sadness.

30 caregivers after care recipient’s death

1 year following care recipient’s death

Symptoms, grief, and distress

QUAN + QUAL

Results

Walker, J. E., Thompson, K. E., & Oliver, A. I.(2014). Maintaining cognitive health in older adults: Australians’ experience of targeted computer-based training, using the Brain Fitness Program. Physical & Occupational Therapy in Geriatrics, 32(4), 397–413.

Evaluation of a brain fitness program (BFP) for older Australians, which uses computer-delivered activities aiming to reduce cognitive decline (over 8 weeks, 40 hours). Statistically significant increases in concentration and attention scores. Easy to use, but hard to follow through to end of activities and repetitive. (pilot)

10 older adults

Within 1 week of completion of program

Cognitive and quality of life scores

QUAN → QUAN + qual*

Results

Wallace, R., Lo, J., & Devine, A.(2016). Tailored nutrition education in the elderly can lead to sustained dietary behaviour change. Journal of Nutrition, Health & Aging, 20(1), 8–15.

To evaluate a nutrition education intervention. The intervention resulted in an increase in knowledge, greater consumption of vegetables, and the use of less salt.

72 older adults

4 weeks

Food knowledge (attitude/confidence toward healthy eating, dietary patterns, cooking behavior), knowledge about dementia

QUAN + QUAL

Results

Wardell, D. W., Decker, S. A., & Engebretson, J. C.(2012). Healing touch for older adults with persistent pain. Holistic Nursing Practice, 26(4), 194–202.

Evaluate effect of “healing touch” (HT) on health outcomes and describe patient experiences through interview, session notes, and provider experiences. Experiences ranged from no benefit to decreased pain and other psychological improvements.

20 (12 intervention only) older adults

2 weeks after last HT session

Pain levels, quality of life, ADL

QUAN → QUAN x 3 → qual → QUAN x 3 → QUAN + qual*

Results

Wenger, G. C., & Burholt, V.(2004). Changes in levels of social isolation and loneliness among older people in a rural area: A twenty-year longitudinal study. Canadian Journal on Aging, 23(2), 115–127.

Predictors of change in loneliness and social isolation in older adults were identified and models were developed; policy implications were discussed.

534 older adults

20 years

Loneliness and social isolation

QUAN + qual (6 time points)

Sample selection/Data analysis (quan outcomes used to identify cases, which highlighted quan and qual data)

Wu, Y. H., Wrobel, J., Cornuet, M., Kerherve, H., Damnee, S., & Rigaud, A. S.(2014). Acceptance of an assistive robot in older adults: A mixed-method study of human-robot interaction over a 1-month period in the Living Lab setting. Clinical Interventions in Aging, 9, 801–811.

Pilot evaluated experience of older adults (cognitively healthy and cognitively impaired) with assistive robots . Both groups could use it, but did not like it and would not want to use it since they did not find it useful. Barriers to robot acceptance: technology, stigma, ethics.

11 cognitively healthy and impaired older adults

4 weeks (end of 4th session with robot)

Robot acceptance, usability-performance

quan → qual → quan (usability) → quan (usability) → qual*

Results

Yau, D. C., Leung, A. C., Yeoh, C. S., & Chow, N. W.(2005). Global case management: Hong Kong. Care for the hospital-discharged frail elders by nurse case managers: A process evaluation of a longitudinal case management service project. Lippincott’s Case Management, 10(4), 203–212.

Process evaluation of a longitudinal case management service project with nurse case managers’ (NCMs) discharge process for frail elders. Common reasons for clients (patients and caregivers) calling NCM and NCM’s responses are identified as well as factors for successful case management.

45 elderly discharged patients and carers/experimental group (quan); 4 nurse case managers (qual)

1 year

NCM real-time records/log sheets of client call content and NCM responses (quantized)

QUAN(qual) → qual*

Results

Yuen, H. K., Mueller, K., Mayor, E., & Azuero, A.(2011). Impact of participation in a theatre programme on quality of life among older adults with chronic conditions: A pilot study. Occupational Therapy International, 18(4), 201–208.

Pilot theater program for older people with chronic conditions (6-week class; 4 performances). Participants reported significantly higher well-being and physical improvement, not improvement in mental health, on subscales of SF36. Interviews found themes of improved self-worth, self-advocacy, and defeating previous self-imposed limitations.

12 older adults with chronic conditions

1 month

SF36, General Wellbeing Schedule

QUAN → QUAN + qual*

Results

Note: 1. n by strand if different.

2. Asterisk denotes our decision.

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